Antimicrobial use for pediatric acute respiratory tract infections and the subsequent emergence of multi-drug resistant bacteria

Abstract

Background: Viruses cause the majority of acute respiratory tract infections (ARTIs). On clinical grounds, differentiation of bacterial vs. viral ARTIs is difficult and warrant costly investigations. In Sri Lanka, ARTIs are commonly treated by family physicians (FP), and severe patients seek inward care. This study was conducted to evaluate the use of antibiotics by FP and by hospital care and the development of antimicrobial resistance (AMR) in children with viral ARTIs. Methods and materials: Nasopharyngeal aspirates of inward patients (1-month to 5-years) with ARTIs were collected in Teaching Hospital, Anuradhapura from March-2013 to August-2014. Using immunofluorescence assay (IFA) specific viral etiology was detected. Phenotypically multi-drug resistant (MDR) bacteria were detected. The use of antibiotics and the development of infectious diseases in the past six months, in the current episode and follow up to 6 months was assessed using questionnaires, telephone interviews, and demonstration of antimicrobials. Multivariate analysis was performed to assess risk factors for the development of MDR microbes. Results: Out of 413 viral etiologies were detected in 40% (165/413). Antibiotics were prescribed in the health care facility for 100% (165/165) of patients with viral ARTIs. Initially, 120 patients were treated by FP, and 100% were on antimicrobials. Following admission, 84 of them were treated with antibiotics. Out of 120, 80 were on co-amoxiclav, 38 were on cephalosporin (cefixime-28; cefuroxime-10), and 2 were on macrolides monotherapy. Everyone was presented to FP on day 1 of illness. Mean ± SD hospital stay for viral ARTIs with and without antimicrobials was 4 ± 1.6 and 4.1 ± 1.8 days and is not significant. Eighty had two episodes of ARTI in the earlier 6-months, and every occasion was treated with antibiotics by FP. In follow up, 102 (75%) and 20 (14.7%) extended-spectrum of beta-lactamases (ESBL) and carbapenemase producers (CRE) were isolated in patients with urinary and other infections. Conclusion: The use of viral diagnostic by FP and in hospitals would be an essential factor in reducing the unnecessary use of antibiotics. The rational antibiotic use will invariably contribute to reduce the cost and to prevent the emergence of ESBL and CRE.