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P337 Antibiotics in respiratory syncytial virus bronchiolitis: is there evidence for prescription?
  1. Popa Corina Steluta,
  2. Dobre Cristian1,
  3. Dracea Laura Larisa1,2,3
  1. 1- Respiratory Diseases Department, Clinical Children’s Hospital, Brasov, Romania
  2. 2- Medicine Faculty, Transylvania University of Brasov, Romania
  3. 3- Department of Mathematical and Statistical Methods, Wageningen University, The Netherlands

Abstract

Background and aims Bronchiolitis is the leading cause for infant and young child hospitalisation, respiratory syncytial virus (RSV) being the most common aetiology. Antibiotics are often prescribed despite guidelines recommendations.

Aim of the study: to investigate the incidence and motivation of antibiotic prescription in RSV bronchiolitis in hospitalised children.

Methods We conducted a retrospective study on patients under 2 years, admitted for RSV bronchiolitis in a tertiary hospital over a 4 months period (September-December 2017). We analysed data from clinical files regarding the incidence and type of antibiotic prescription correlated with it’s effect on hospitalisation duration, association with risk factors for adverse outcomes (prematurity, age under 2 months, congenital heart disease, malnutrition), concomitant bacterial infection, pre-hospital antibiotic use, chest X-ray changes, nasal colonisation, inflammatory markers, oxygen saturation.

Study population was divided in two groups: A –with and B- without antibiotic prescription. Fisher test was used for statistical analysis, p<0.05.

Results 64 patients were included, out of whom 42 (65%) received antibiotic treatment: 29 (45%) ampicillin/amoxicillin and 12 (18%) cephalosporins. Mean treatment duration was 5.7 days. Hospital stay was longer in group A (p=0.001).There was no statistical significance between groups in terms of inflammatory markers, pre-hospital antibiotic treatment, nasal colonisation and modified chest x-ray, respiratory distress. Any associated risk factor found in 27 patients (42%) was not correlated with incidence of antibiotic prescription (p=0.162), but was associated with a longer hospitalisation period. Concomitant bacterial infection (18 patients) was correlated with antibiotic prescription (p=0.02). For 22 patients antibiotic was started from admission.

Conclusions Antibiotic prescription was identified in patients with a longer hospitalisation, possibly due to association with risk factors. In patients with concomitant bacterial infection, antibiotic prescription was justified.

Although guidelines advise for no antibiotic policy in bronchiolitis, ambiguity of clinical diagnosis may compel paediatrician to start empirically treatment, even no sufficient evidence for justifying this.

Overuse of antibiotics in hospital settings has to be discouraged and subgroups of patients who may benefit from them in bronchiolitis, should be identified.

  • antibiotics
  • bronchiolitis

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