Antibiotic misuse in respiratory tract infections in children and adults—a prospective, multicentre study (TAILORED Treatment)
van Houten, Chantal B.; Cohen, Asi; Engelhard, Dan; Hays, John P.; Karlsson, Roger; Moore, Edward; Fernández, David; Kreisberg, Racheli; Collins, Laurence V.; de Waal, Wouter; de Winter-de Groot, Karin M.; Wolfs, Tom F.W.; Meijers, Pieter; Luijk, Bart; Oosterheert, Jan Jelrik; Heijligenberg, Rik; Sankatsing, Sanjay U.C.; Bossink, Aik W.J.; Stubbs, Andrew; Stein, Michal; Reisfeld, Sharon; Klein, Adi; Rachmilevitch, Ronit; Ashkar, Jalal; Braverman, Itzhak; Kartun, Valery; Chistyakov, Irena; Bamberger, Ellen; Srugo, Isaac; Odeh, Majed; Schiff, Elad; Dotan, Yaniv; Boico, Olga; Navon, Roy; Friedman, Tom; Etshtein, Liat; Paz, Meital; Gottlieb, Tanya M.; Pri-Or, Ester; Kronenfeld, Gali; Simon, Einav; Oved, Kfir; Eden, Eran; Bont, Louis J.
(2019) European Journal of Clinical Microbiology and Infectious Diseases, volume 38, issue 3, pp. 505 - 514
(Article)
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
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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, 1.3 years and 64.5 years, 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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Keywords: Antibiotic use, Infectious diseases, Pulmonology, Respiratory tract infections, Microbiology (medical), Infectious Diseases
ISSN: 0934-9723
Publisher: Springer-Verlag
Note: Funding Information: Funding The TAILORED Treatment study was supported by the European Union’s Seventh Framework Programme (grant number 602860). Funding Information: We thank the study team from the University Medical Centre Utrecht, The Netherlands (Brigitte Buiteman, Maaike van der Lee, Wouter van der Valk) and from MeMed Diagnostics, Tirat Carmel, Israel (Liran Shani, Omer Sadeh, Stav Rakedzon, Tzah Feldman) for patient recruitment and data collection. Publisher Copyright: © 2019, The Author(s).
(Peer reviewed)
