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

Chantal B. van Houten, Asi Cohen, Dan Engelhard, John P. Hays, Roger Karlsson, Edward Moore, David Fernández, Racheli Kreisberg, Laurence V. Collins, Wouter de Waal, Karin M. de Winter-de Groot, Tom F.W. Wolfs, Pieter Meijers, Bart Luijk, Jan Jelrik Oosterheert, Rik Heijligenberg, Sanjay U.C. Sankatsing, Aik W.J. Bossink, Andrew Stubbs, Michal SteinSharon Reisfeld, Adi Klein, Ronit Rachmilevitch, Jalal Ashkar, Itzhak Braverman, Valery Kartun, Irena Chistyakov, Ellen Bamberger, Isaac Srugo, Majed Odeh, Elad Schiff, Yaniv Dotan, Olga Boico, Roy Navon, Tom Friedman, Liat Etshtein, Meital Paz, Tanya M. Gottlieb, Ester Pri-Or, Gali Kronenfeld, Einav Simon, Kfir Oved, Eran Eden, Louis J. Bont*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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, 1.3 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.

Original languageEnglish
Pages (from-to)505-514
Number of pages10
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume38
Issue number3
DOIs
StatePublished - 4 Mar 2019
Externally publishedYes

Keywords

  • Antibiotic use
  • Infectious diseases
  • Pulmonology
  • Respiratory tract infections

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