Assessing the use of antibiotics and the burden of varicella in Belgium using a retrospective GP database analysis

Abstract

Background Varicella is a highly contagious infection that typically occurs in childhood. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur. Objectives The objective of this study was to characterize the burden of varicella in a real-world primary care setting in Belgium, including the rate of varicella-related complications, medication management and general practitioner (GP) visits. Methods The study was a retrospective observational study using data from a longitudinal patient database in a primary care setting in Belgium. Patients with a GP visit and a varicella diagnosis between January 2016 and June 2019 were eligible and data one month prior and three months after the diagnosis were included. Outcomes included varicella-related complications, antibiotic use, antiviral use, and GP follow-up visits. Antibiotic use could be specified by class of antibiotic and linked to a diagnosis. Complications were identified based on concomitant diagnosis with varicella during the study period. Results 3,847 patients with diagnosis of varicella were included, with a mean age of 8.4 years and a comparable distribution of gender. 12.6% of patients with varicella had a concomitant diagnosis of a varicella-related complication. During the follow-up period, 27.3% of patients with varicella were prescribed antibiotics, either systemic (19.8%) and/or topical (10.3%). The highest rate of antibiotic prescriptions was observed in patients with complications (63.5%) and in patients younger than 1 year (41.8%). Nevertheless, 5.3% of the patients were prescribed antibiotics without a concomitant diagnosis of another infection. The most commonly prescribed systemic antibiotics were amoxicillin alone or combined with beta-lactamase inhibitor, and thiamphenicol. Fusidic acid and tobramycin were the most prescribed topical antibiotics. Antivirals were prescribed for 2.7% of the study population. 4.7% of the patients needed a follow-up visit with their GP. Conclusions This study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use.

Assessing the use of antibiotics in pediatric patients hospitalized for varicella

“…The percentage of antibiotics used among varicella patients was higher than the 19.8% reported in Belgium [ 21 ]. A main explanation of this is that in our study just hospitalized patients were included, so that the disease course was likely more severe.…”

Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France

“…For example, in Belgium, 12.6% of varicella patients in primary care experienced a complication, while in England, 7.7% of patients in primary or secondary care experienced a complication. 11,37 Analgesics and antihistamines were the 2 most prescribed medication classes in this study cohort. Similar findings have been reported in a previous study in Argentina, which found high levels of over-the-counter medication use, which included analgesics and antihistamines.…”

“…8 , 9 Primary care physicians may also prescribe antivirals, analgesics, antihistamines or antibiotics. 8 , 10 , 11 More severe varicella cases have been associated with complications including, infections of the skin and soft tissue, pneumonia or encephalitis, that may result in hospitalization. 1 It is estimated that complications occur in 2% to 6% of all varicella cases.…”

Vaccination coverage in Italian children and antimicrobial resistance: an ecological analysis

“…While our previous study suggested how increasing influenza vaccination coverage could help in the fight against AMR [ 14 ], there is no evidence regarding the potential effect of varicella vaccine. Yet, it has been reported that antibiotics are regularly prescribed for the management of patients with varicella, often without any mention of complications or microbiological confirmation [ 37 , 38 ]. For this reason, it is possible to assume that even varicella vaccine could be effective in reducing the incidence of infections sustained by antimicrobial-resistant pathogens [ 39 ].…”