
A study of US pediatric outpatient prescriptions over a 10-year period found that flu and respiratory syncytial virus (RSV) are associated with meaningful proportions of pediatric antibiotic prescribing, researchers reported last week in the Journal of Infectious Diseases.
In an analysis of data from a large commercial insurance database, researchers from the University of California-Berkeley and the University of Alabama at Birmingham examined medical visits and outpatient pharmacy prescriptions in children aged 0 to 17 years from 2008 and 2018.
The primary outcome was the incidence and attributable fractions of antibiotic prescriptions associated with RSV and influenza. While both viruses are known to be common causes of acute respiratory infections (ARIs) in children, data on their role in outpatient pediatric antibiotic prescribing are limited.
During the study period, more than 21.5 million outpatient antibiotic prescriptions were dispensed, two-thirds (66.8%) of which were associated with an ARI diagnosis. Using negative binomial regression models, the researchers estimated that 6.3% (95% confidence interval [CI], 5.2% to 7.3%) of all antibiotic prescriptions were associated with RSV and 3.4% (95% CI, 3.1% to 3.8%) were associated with flu. These estimates translated to 72.6 RSV-associated and 40.0 flu-associated antibiotic prescriptions per 1,000 children annually.
More antibiotics prescribed in peak RSV, flu years
Both estimates varied widely across study years, with RSV-associated antibiotic prescribing exceeding 10% in peak RSV years and flu-associated prescribing exceeding 20% in peak flu years.
RSV-associated antibiotic prescription incidence was highest among children aged 5 years and under and linked to pneumonia, bronchiolitis, and acute otitis media (ear infection) diagnoses, while flu-associated antibiotic prescriptions were highest among children over 5 years and more commonly linked with viral upper respiratory infection and bronchitis diagnoses.
The study authors say the findings support vaccination and other measures to reduce RSV and influenza in children.
"Beyond disease burden reductions, immunization against these pathogens may reduce antibiotic use, an important step in mitigating antibiotic resistance," they wrote.