The Use of Antibiotics in the Treatment of Pediatric Varicella Patients: Evidence from the multi-country MARVEL study

Abstract

Background: Varicella is a common infectious disease in childhood that can result in bacterial complications such as skin and soft tissue infections and pneumonias, among others. Although well-tolerated and effective varicella vaccines have been available for >20 years, only 40 countries around the world have implemented universal varicella vaccination (UVV) programmes. The objective of this study was to examine empiric data on the appropriate and inappropriate use of antibiotics in the treatment of pediatric varicella patients, based on data collected in five countries (Argentina, Hungary, Mexico, Peru, and Poland). Methods & Materials: Five primary data collection studies were conducted between 2014-2017 as part of MARVEL (Multi-country economic and epidemiological burden of varicella study). Detailed data were obtained on the treatment of primary varicella in both inpatients and outpatients aged 1-14 years between 2009-2016. We descriptively analyzed data on the type of complications, severity of disease (measured by number of lesions), and dosage and duration of both prescription and non-prescription antibiotic use, together with data on whether or not a confirmation of the presence of bacterial infections was available. These results were contrasted within countries to treatment guidelines for varicella and the use of antibiotics to assess appropriate and inappropriate use, and between countries to compare utilization patterns. Results: Across the 5 countries, 787 patient records were included (401 outpatients, 386 inpatients). The average number of antibiotics used per inpatient ranged from 0.9 in Poland to 1.9 in Peru, with an average duration of use of 7.2 days (Hungary) to 15.8 days (Mexico) among users. Among outpatients, this ranged from 0.03 antibiotics in Hungary to 0.4 antibiotics in Argentina, with an average duration of antibiotics used of 6.5 days (Peru) to 9.5 days (Argentina). The proportion of antibiotics prescribed without a probable or confirmed diagnosis of bacterial infection ranged from 44.3% (Hungary) to 89.9% (Peru). Conclusion: UVV could substantially reduce both inappropriate and appropriate use of antibiotics in pediatric varicella patients, and could be a valuable tool in an arsenal to combat antimicrobial resistance. Further studies on the gap between appropriate and inappropriate use of antibiotics in the treatment of varicella may be warranted.