How to reduce the use of antibiotics in infant bronchiolitis?

Korppi, Matti

doi:10.1111/apa.15165

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Antibiotic therapy is not indicated for uncomplicated bronchiolitis, caused by viruses [11]. However, antibiotics are commonly prescribed for infants with severe bronchiolitis in an attempt to empirically treat a potential bacterial superinfection [12]. Intra-abdominal infections accounted for 10.6% of all amoxicillin and clavulanate prescriptions.…”

Section: Discussionmentioning

confidence: 99%

Trends in Antibiotic Use in a Large Children’s Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys

Meesters,

Chappell,

Demirjian

2024

Antibiotics

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Background: Antibiotics are commonly prescribed in paediatrics. As their excessive use contributes to adverse drug events, increased healthcare costs, and antimicrobial resistance, antimicrobial stewardship initiatives are essential to optimising medical care. These single-centre point prevalence surveys aimed to provide insights into antibiotic prescribing trends and identify targets for paediatric AMS activities. Methods: 14 point prevalence surveys were conducted from March 2016–April 2021, collecting data on antibiotic prescriptions, indication, adherence to guidelines, and route of administration. The UK adapted the World Health Organisation’s AWaRe classification-guided antibiotic categorization. Results: 32.5% of all inpatients were on at least one antimicrobial; this remained stable during all surveys (range: 20–44%, p = 0.448). Of all prescriptions, 67.2% had an end- or review-date, and the majority was for agents in the Watch category (46.8–70.5%). Amoxicillin and clavulanate were the most frequently prescribed antibiotics (20.8%), followed by gentamicin (15.3%). Approximately 28.8% of all prescriptions were for prophylactic indications, while 7.6% of the prescriptions were not adherent to the hospital guidelines. Conclusions: This study highlights the importance of ongoing monitoring and robust AMS initiatives to ensure prudent antibiotic prescribing in paediatric healthcare. It underscores the need for tailored guidelines, educational efforts, and targeted interventions to enhance the quality of antibiotic usage, ultimately benefiting both individual patients and public health.

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Section: Discussionmentioning

confidence: 99%

Trends in Antibiotic Use in a Large Children’s Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys

Meesters,

Chappell,

Demirjian

2024

Antibiotics

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“…It should be noted that bronchiolitis is a clinical diagnosis, and blood tests and chest X-rays, are not routinely recommended in line with national and international guidelines [ 1 , 18 , 19 ]. However, other studies aiming to reduce antibiotic prescription in infants with severe bronchiolitis have investigated the use of PCT and PCR biomarkers [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

A Procalcitonin and C-Reactive Protein-Guided Clinical Pathway for Reducing Antibiotic Use in Children Hospitalized with Bronchiolitis

et al. 2021

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Despite the lack of evidence that bronchodilators, corticosteroids, and antibiotics are useful in treating bronchiolitis, their use is still widespread. This study aimed to determine the consumption of antibiotics for bronchiolitis before and after a procalcitonin-guided clinical pathway (CP) implementation. In December 2019, a CP for lower respiratory tract infection management was implemented at the Department of Women’s and Children’s Health at Padua University Hospital. This was a pre-post, quasi-experimental study that assessed the changes in the treatment of bronchiolitis during two bimesters preceding the CP implementation (pre-period: January 2018–February 2018 and January 2019–February 2019) and during the bimester after CP implementation (post-period January 2020–February 2020). After the CP implementation, there was a significant reduction in antibiotic prescriptions from 36.2% to 12.5% (p = 0.036) in patients hospitalized for bronchiolitis. Co-amoxiclav treatment, the antibiotic most commonly administered, decreased from 66.6% to 33.3%. Among outpatients’ bronchiolitis episodes, a statistically significant decrease in beta2-agonists’ use (from 18.0% to 4.4%, pre and post periods) and a quasi-significant decrease in corticosteroid use (from 8.0% to 0% pre and post periods) were observed. An evidence-based CP supported by educational lectures was associated with significant changes in the physicians’ prescribing habits.

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Effect of azithromycin administration in cases of acute bronchiolitis – A systematic review and meta-analysis

Tamilarasan,

Thandapani,

Mary

et al. 2023

GJHSR

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Acute Bronchiolitis is the most common viral lower respiratory tract infection in infants requiring hospitalization. Management is usually symptomatic and supportive with no specific treatment options. Although viral, Azithromycin by its anti-inflammatory properties might play a role in improving the clinical outcome. The objective was to assess the effect of azithromycin on length of hospital stay and duration of oxygen requirement in cases of acute bronchiolitis. Data sources such as PubMed and Google Scholar were systematically searched till June 2023. The meta-analysis included all published, randomized controlled trials that investigated the efficacy of Azithromycin over placebo in infants <24 months with acute bronchiolitis. Data extraction was guided by a predetermined checklist. Using RevMan 5 software, the mean length of hospital stay and duration of oxygen administration were pooled from the selected studies. The fixed-effect model was used to compare the length of hospital stay and the duration of oxygen administration in the Azithromycin and placebo group. Data analyses were performed in July 2023. The primary outcome was a comparison of the length of hospital stay in infants with Bronchiolitis receiving either azithromycin (intervention) or placebo (control). The secondary outcome was the assessment of the duration of oxygen requirement in both intervention and control groups.The initial search yielded 601 records of which 68 articles underwent full-text evaluation, which identified four articles and a total of 571 patients that were included. The findings did not favor the usage of azithromycin antibiotic in treatment of acute bronchiolitis (Mean deviation = 1.21, 95% CI 0.53–2.78, P = 0.80). An insignificant Q statistic (P = 0.001) indicated the absence of heterogeneity (I2 = 0%). Length of hospital stay showed an overall insignificant effect as the length of stay is almost similar in both drugs (OR = 1.04 95% CI 0.49–2.23, P = 1.00). An insignificant Q statistic (P = 1.00) indicated the absence of heterogeneity (I2 = 0%).

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How to reduce the use of antibiotics in infant bronchiolitis?

Cited by 4 publications

References 10 publications

Trends in Antibiotic Use in a Large Children’s Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys

Trends in Antibiotic Use in a Large Children’s Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys

A Procalcitonin and C-Reactive Protein-Guided Clinical Pathway for Reducing Antibiotic Use in Children Hospitalized with Bronchiolitis

Effect of azithromycin administration in cases of acute bronchiolitis – A systematic review and meta-analysis

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