The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe

Abstract

Background Varicella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation. Methods Pooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1–14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country. Results Four hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, β-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%. Conclusions High rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications. Electronic supplementary material The online version of this article (10.1186/s12889-019-7071-z) contains supplementary material, which is available to authorized users.

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

“…Only 8 patients had complications identified through the ICD-10-CM code for varicella (n = 6 with varicella meningitis and n = 2 with varicella encephalitis). When using the second approach for identification of varicella-related complications (as described in the “Materials and methods” section), 12.6% (n = 406) of the eligible patients had a concomitant diagnosis corresponding to a medical condition from the list derived from Blumental et al [ 12 ] and Wolfson et al [ 20 ] (Table 1 ). The most commonly identified complications over the 4-month period around the index-date were acute bronchitis (41.4%), skin and sub-tissue infections (39.4%), pneumonia (11.3%) and acute bronchiolitis (8.1%).…”

“… a Complications reported with/without hard-code link with varicella over the 1-month before and 3-month period after the index-visit. The list of complications was derived from Blumental et al [ 12 ] and Wolfson et al [ 20 ] …”

“…Therefore, in order to avoid a systematic underestimation of the rate of complication, a second approach was also taken, consisting of looking for concomitant diagnostic codes distinct from varicella but corresponding to common complications associated with varicella. A list of ICD-10-CM codes was compiled from the studies of Blumental et al [ 12 ] and Wolfson et al [ 20 ], resulting in the following diagnoses to be searched: varicella meningitis, varicella encephalitis, myelitis and encephalomyelitis, sepsis, hepatitis, hordeolum of eyelid, keratoconjunctivitis, pneumonia, acute bronchitis, acute bronchiolitis, cellulitis and abscess of mouth, local infection of the skin and subcutaneous tissue, arthritis and nephritis.…”

“…In line with these observations, a recent study reported that antibiotics are regularly prescribed for the management of varicella-related complications. Antibiotics prescriptions also occurred without any mention of complications or a microbiological confirmation [ 20 ]. Vaccination can be one of the measures to help reduce the use of antibiotics via the prevention and control of infections [ 18 ].…”

Complicações das internações por varicela em um hospital de referência em Fortaleza- Ceará, 2012-2018

“…Em nosso estudo, o uso do antiviral em conjunto com a antibioticoterapia foi o mais relatado (44%). Estudo aponta o uso do antibiótico como escolha no tratamento da varicela com complicações associadas a infecções bacterianas 46 . O uso do aciclovir dentro de 24 horas após o desenvolvimento da erupção cutânea tem demonstrado redução da duração da febre e dos sintomas da infecção 47 .…”