Abstract
BackgroundKnowledge of key drivers for antibiotic prescribing in pediatric lower respiratory tract infection (LRTI) could support rational antibiotic use. Thus, we aimed to determine the impact of clinical and laboratory factors on antibiotic prescribing in children and adolescents with febrile LRTI.MethodsPediatric patients from the standard care control group of a randomized controlled trial (ProPAED) investigating procalcitonin guided antibiotic treatment in febrile LRTI were included in a multivariate logistic regression analysis to evaluate the impact of laboratory and clinical factors on antibiotic prescribing.ResultsThe standard care control group of the ProPAED study comprised 165 LRTI patients (median age: 2.7 years, range: 0.1–16), out of which 88 (55%) received antibiotic treatment. Factors significantly associated with antibiotic prescribing in patients with complete clinical and laboratory documentation (n = 158) were C-reactive protein (OR 5.8 for a 10-fold increase, 95%CI 2.2–14.9), white blood count beyond age-dependent reference range (OR 3.9, 95%CI 1.4–11.4), body temperature (OR 1.7 for an increase by 1°C, 95%CI 1.02–2.68), and pleuritic pain (OR 2.8, 95%CI 1.1–7.6). Dyspnea (OR 0.3, 95%CI 0.1–0.7) and wheezing (OR 0.3, 95%CI 0.13–0.95) were inversely associated with antibiotic prescribing.ConclusionLaboratory markers were strong drivers of antibiotic prescribing in children with febrile lower respiratory tract infections, in spite of their known poor prediction of antibiotic need. Building on current guidelines for antibiotic treatment in children with febrile LRTI, a reliable decision algorithm for safe antibiotic withholding considering the laboratory and clinical factors evaluated in this study has the potential to further reduce antibiotic prescribing.
Highlights
Lower respiratory tract infections (LRTI) bear high mortality and morbidity in children and adolescents with community acquired pneumonia (CAP) being the leading cause of death worldwide with 1.3 million fatal pediatric cases each year [1]
Pediatric patients from the standard care control group of a randomized controlled trial (ProPAED) investigating procalcitonin guided antibiotic treatment in febrile lower respiratory tract infection (LRTI) were included in a multivariate logistic regression analysis to evaluate the impact of laboratory and clinical factors on antibiotic prescribing
Factors significantly associated with antibiotic prescribing in patients with complete clinical and laboratory documentation (n = 158) were C-reactive protein, white blood count beyond age-dependent reference range, body temperature, and pleuritic pain
Summary
Lower respiratory tract infections (LRTI) bear high mortality and morbidity in children and adolescents with community acquired pneumonia (CAP) being the leading cause of death worldwide with 1.3 million fatal pediatric cases each year [1]. Given that adult studies have identified e.g. a strong impact of Creactive protein (CRP) (odds ratio 98.1 for exceeding 50 mg/L) on physicians‘decision to prescribe antibiotic medication for LRTI [9] there is a need for clarification of what sways the decision to prescribe antibiotics for LRTI in children and adolescents. We aimed at characterizing the laboratory and clinical drivers of antibiotic prescribing for pediatric LRTI with a subanalysis of the ProPAED trial [10].
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