Acute viral bronchiolitis is the most common lower respiratory tract infection in children under two years old and carries a less than 1% risk of bacterial co-infection. The American Academy of Pediatrics released a recommendation in 2006 and an update in 2014 against routine antibiotic treatment in children without documented bacterial infection, but approximately one-third of children were prescribed antibiotics in US emergency departments between 2001 and 2009.
This study aimed to evaluate the proportion of infants diagnosed with bronchiolitis in U.S. emergency departments who were prescribed antibiotics after the AAP guideline release and update, as well to ass factors associated with inappropriate antibiotic use.
Study was conducted over 9 years (2007-2015) representing over 2.92 million ED visits for bronchiolitis in children < 2 years of age. Median age was 8 months and 89.7% of patients were discharged, and 11.9% of patients were diagnosed with an additional bacterial infection, most commonly acute otitis media. 25.6% of patients received antibiotics, with no significant difference between admitted and non-admitted patients. Among infants who received antibiotic treatment, 69.9% had no documented concomitant bacterial infection.
Study also found that there was no decrease in antibiotic prescribing during the 9 years after AAP guideline publication. Given that more than 70% of infants discharged from ED with antibiotics had no documented bacterial infection, and only a 1% risk of concomitant bacterial and viral infection in the setting of bronchiolitis, the study concluded that over-prescribing can be safely reduced. The study highlights the minimal improvement over two decades regarding antibiotic prescribing, deeming this an ongoing problem contributing to increased risks of adverse effects and increasing bacterial resistance.
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