Abstract
BackgroundVaricella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation.MethodsPooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1–14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country.ResultsFour hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, β-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%.ConclusionsHigh rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications.
Highlights
Varicella is a highly contagious childhood disease
Burden of illness associated with varicella in patients ≤14 years of age was evaluated in Argentina (2009–2014) [8], Hungary (2011–2015) [11], Mexico (2011–2016) [12], Peru (2011–2016) (Castillo M, et al Economic burden of varicella in children in peru, 20112016, Forthcoming), and Poland (2010–2015) [13]
The results of this study demonstrate that, among pediatric varicella cases in the 5 studied countries, rates of infectious complications in outpatient (12.2%) and inpatient (78.8%) settings are considerable, with approximately 33% of all inpatient complications involving a bacterial infection, of which > 15% were confirmed microbiologically
Summary
Varicella is a highly contagious childhood disease. Serious complications necessitating antibiotic use may occur. Varicella zoster virus (VZV) is a highly contagious disease infecting between 2 and 16 per 1000 individuals annually worldwide [1–3]. A childhood affliction, regional variations in incidence rates and age distribution are attributed to factors such as population density, climate, and earlier preschool/out-of-home care in children [4, 5]. Usually following a benign course of disease, varicella can result in serious complications. The most commonly observed are skin and soft tissue infections, and neurological complications [7]. Up to 28% of varicella outpatients have been found to report complications [8], with skin and soft tissue infections accounting for up to 90% of these [8]. Treatment of varicella-related complications in both inpatient and outpatient settings may involve use of antibiotic agents
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