High prescribing rates of third-generation cephalosporins in children hospitalized with acute lower respiratory infections at a university hospital

• Published in: International journal of infectious diseases Vol. 102; pp. 369 - 374
• Main Authors: Wacharachaisurapol, Noppadol, Jitrungruengnij, Nattapong, Janewongwirot, Pakpoom, Suchartlikitwong, Pintip, Chautrakarn, Sineenart, Jantarabenjakul, Watsamon, Anugulruengkitt, Suvaporn, Theerawit, Tuangtip, Sophonphan, Jiratchaya, Deerojanawong, Jitladda, Pancharoen, Chitsanu, Puthanakit, Thanyawee
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01-01-2021; Elsevier
• Subjects: Acute Disease; Acute lower respiratory infections; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial Stewardship; Cephalosporins - therapeutic use; Child, Preschool; Community-acquired pneumonia; Drug Prescriptions - statistics & numerical data; Female; Hospitals, University; Humans; Infant; Male; Paediatrics; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - microbiology; Retrospective Studies; Acute lower respiratory infections; Antimicrobial stewardship; Community-acquired pneumonia; Antibiotics; Paediatrics
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.10.105

•Antibiotics are frequently prescribed for children under 5 years of age hospitalized with acute lower respiratory infections.•Age >2–5 years and having a co-morbidity are the significant drivers.•Third-generation cephalosporins are the most prescribed antibiotics, and this could be decreased.•Antibiotic guidelines and an antimicrobial stewardship programme should be implemented as a matter of urgency.
Antibiotics are frequently prescribed for the treatment of acute lower respiratory infections (ALRI) in children ≤5 years of age, even though viral aetiologies are the most common. The aim of this study was to describe antibiotic prescribing rates and patterns in children ≤5 years of age hospitalized with ALRI.
A retrospective study was conducted involving patients aged 1 month to 5 years hospitalized with ALRI at a university hospital. Patient demographics, ALRI diagnosis, microbiological data, antibiotics prescribed, and treatment outcomes were recorded and analysed.
A total of 1283 patients were enrolled. Their median age was 1.6 years (interquartile range 0.8–2.8 years). Thirty-six percent had a co-morbidity. The diagnosis at discharge was viral ALRI in 81% and bacterial pneumonia in 19%. The mortality rate was 0.4%. The overall antibiotic prescribing rate was 46% (95% confidence interval 43–49%). Antibiotic prescribing rates were higher among children with co-morbidities (65% vs 35%, p < 0.001) and older children (57% for >2–5 years vs 39% for ≤2 years, p < 0.001). Parenteral third-generation cephalosporins were prescribed in up to 68% of all prescriptions.
Nearly-half of hospitalized children with ALRI were prescribed antibiotics. The majority of prescribed antibiotics were third-generation cephalosporins. An antimicrobial stewardship programme and antibiotic guidelines should be implemented to promote the judicious use of antibiotics.