Antibiotic misuse in respiratory tract infections in children and adults\u2014a prospective, multicentre study (TAILORED Treatment)

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

doi:10.1007/s10096-018-03454-2

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.

Highlights

Acute respiratory tract infections (RTIs) are one of the leading causes of emergency department (ED) visits and are often due to viral pathogens [1,2,3,4]
Influenza virus was detected in four of them. This convenience cohort of patients from the TTT biomarker study is the first prospective study comparing the burden of antibiotic misuse in both children and adults diagnosed with RTI, using an expert panel adjudication as the reference standard [18]
We observed that antibiotic overuse was less common in children than in adults with a viral RTI (37% versus 83%), regardless of viral aetiology

Summary

Introduction

Extended author information available on the last page of the article problem of antibiotic overuse in RTI is largest in adults [4,5,6]. There are increasing efforts to study host-biomarkers that could discriminate bacterial from non-bacterial infections [12]. A prospective, international study (The “TAILORED Treatment” (TTT) study) was designed to generate a multi-parametric model for distinguishing between bacterial and viral infections based on new host- or pathogen-related biomarkers [13]. As a gold standard to diagnose bacterial infections is missing, this study used

Methods

Results

Conclusion