Antibiotics overused in children with RSV lower respiratory tract infection
Antibiotics has been administered unnecessarily to as many as one-third of children with respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) in hospitals in the Netherlands and Israel, according to a prospective international multicentre RSV study using an expert panel as reference standard to identify children with and without bacterial coinfection.
Of the 784 recruited patients, 188 (24 percent) were positive for RSV. Ninety-two (49 percent) of all RSV-positive children were treated with antibiotics, and 27 (29 percent) with bacterial coinfection were also treated with antibiotics.
In addition, antibiotics was administered to 57 patients (62 percent) without a diagnosis of bacterial coinfection. Of note, the expert panel could not distinguish simple viral from bacterial infection in eight (9 percent) of the 92 RSV-positive patients treated with antibiotics.
The study prospectively recruited children ≥1 month of age with LRTI or fever without source and assessed the incidence of bacterial coinfections and the amount of antibiotic overuse in those infected with RSV. The expert panel as reference standard diagnosis evaluated children with confirmed RSV infection by Polymerase Chain Reaction.
Three experienced paediatricians distinguished bacterial coinfection from simple viral infection using all available clinical information, including all microbiologic evaluations and a 28-day follow-up evaluation.
“RSV is the most common cause of LRTI during the first year of life. Antibiotic treatment is recommended in cases suspected of bacterial coinfection,” the authors said.