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Antibiotic misuse in respiratory tract infections in children and adultsa prospective, multicentre study (TAILORED Treatment)

Journal article
Authors C. B. van Houten
A. Cohen
D. Engelhard
J. P. Hays
Roger Karlsson
Edward R.B. Moore
D. Fernandez
R. Kreisberg
L. V. Collins
W. de Waal
K. M. de Winter-de Groot
T. F. W. Wolfs
P. Meijers
B. Luijk
J. J. Oosterheert
R. Heijligenberg
S. U. C. Sankatsing
A. W. J. Bossink
A. Stubbs
M. Stein
S. Reisfeld
A. Klein
R. Rachmilevitch
J. Ashkar
I. Braverman
V. Kartun
I. Chistyakov
E. Bamberger
I. Srugo
M. Odeh
E. Schiff
Y. Dotan
O. Boico
R. Navon
T. Friedman
L. Etshtein
M. Paz
T. M. Gottlieb
E. Pri-Or
G. Kronenfeld
E. Simon
K. Oved
E. Eden
L. J. Bont
Published in European Journal of Clinical Microbiology & Infectious Diseases
Volume 38
Issue 3
Pages 505-514
ISSN 0934-9723
Publication year 2019
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 505-514
Language en
Links dx.doi.org/10.1007/s10096-018-03454...
Keywords Antibiotic use, Pulmonology, Infectious diseases, Respiratory tract infections
Subject categories Infectious Medicine

Abstract

Respiratory tract infections (RTI) are more commonly caused by viral pathogens in children than in adults. Surprisingly, little is known about antibiotic use in children as compared to adults with RTI. This prospective study aimed to determine antibiotic misuse in children and adults with RTI, using an expert panel reference standard, in order to prioritise the target age population for antibiotic stewardship interventions. We recruited children and adults who presented at the emergency department or were hospitalised with clinical presentation of RTI in The Netherlands and Israel. A panel of three experienced physicians adjudicated a reference standard diagnosis (i.e. bacterial or viral infection) for all the patients using all available clinical and laboratory information, including a 28-day follow-up assessment. The cohort included 284 children and 232 adults with RTI (median age, 1.3years and 64.5years, respectively). The proportion of viral infections was larger in children than in adults (209(74%) versus 89(38%), p<0.001). In case of viral RTI, antibiotics were prescribed (i.e. overuse) less frequently in children than in adults (77/209 (37%) versus 74/89 (83%), p<0.001). One (1%) child and three (2%) adults with bacterial infection were not treated with antibiotics (i.e. underuse); all were mild cases. This international, prospective study confirms major antibiotic overuse in patients with RTI. Viral infection is more common in children, but antibiotic overuse is more frequent in adults with viral RTI. Together, these findings support the need for effective interventions to decrease antibiotic overuse in RTI patients of all ages.

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