Abstract
Despite the lack of evidence that bronchodilators, corticosteroids, and antibiotics are useful in treating bronchiolitis, their use is still widespread. This study aimed to determine the consumption of antibiotics for bronchiolitis before and after a procalcitonin-guided clinical pathway (CP) implementation. In December 2019, a CP for lower respiratory tract infection management was implemented at the Department of Women’s and Children’s Health at Padua University Hospital. This was a pre-post, quasi-experimental study that assessed the changes in the treatment of bronchiolitis during two bimesters preceding the CP implementation (pre-period: January 2018–February 2018 and January 2019–February 2019) and during the bimester after CP implementation (post-period January 2020–February 2020). After the CP implementation, there was a significant reduction in antibiotic prescriptions from 36.2% to 12.5% (p = 0.036) in patients hospitalized for bronchiolitis. Co-amoxiclav treatment, the antibiotic most commonly administered, decreased from 66.6% to 33.3%. Among outpatients’ bronchiolitis episodes, a statistically significant decrease in beta2-agonists’ use (from 18.0% to 4.4%, pre and post periods) and a quasi-significant decrease in corticosteroid use (from 8.0% to 0% pre and post periods) were observed. An evidence-based CP supported by educational lectures was associated with significant changes in the physicians’ prescribing habits.
Highlights
Bronchiolitis is the most common lower respiratory tract infection (LRTI) in children less than one year of age and has a mainly viral etiology [1,2,3]
In the presence of bacterial infection, the biomarker procalcitonin (PCT) is produced in the parenchymal tissues mediated by cytokines IL-6, TNF-α, and IL-β, and the degree of PCT rise correlates with the severity of the infection
The primary aim of this study was to determine the consumption of antibiotics for bronchiolitis before and after the implementation of a PCT/PCR-guided clinical pathway (CP)
Summary
Bronchiolitis is the most common lower respiratory tract infection (LRTI) in children less than one year of age and has a mainly viral etiology [1,2,3]. It is a self-limiting disease; management should focus on supportive care based on oxygen therapy and fluid supplementation [4]. The lack of clinical, radiological, and laboratory tests to safely rule out bacterial involvement in LRTI still drives antibiotic treatment today [6]. PCT production is attenuated by interferon-γ primarily secreted in response to viral infection [6,7,8,9,10]
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