Samson L, Cooke C, Macdonald N
Children's Hospital of Eastern Ontario, Ottawa, Ontario.
Paediatr Child Health. 1999 Apr;4(3):195-9.
To determine the extent of, rationale for and acquisition cost of antibiotic use in a cohort of children with lower respiratory tract infection (LRI) secondary to the respiratory syncytial virus (RSV).
Prospective, observational cohort study.
Patients younger than two years of age admitted to a tertiary care paediatric hospital with a clinical diagnosis of LRI and positive direct immunoflourescence microscopy and/or viral culture for RSV were eligible. Patients older than two years with underlying cardiac abnormalities, respiratory disease or immunosuppression were also eligible. Patients were enrolled as part of the Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of RSV-related LRI.
One hundred and fifty-two patients were enrolled between January 1 and April 30, 1993. Median age was 5.6 months (range 0.2 to 151 months); the male to female ratio was 1.6:1. Morbidity was comparable with that of previously reported cohorts, and no patients died. Sixty-seven (44%) patients received an antibiotic before hospitalization, and ninety-two (60.5%) received at least one antibiotic during hospitalization. Of those receiving antibiotics in hospital, 65 were given oral and 44 intravenous preparations. Reasons for antibiotic prescription during hospitalization were otitis media (37%), 'pneumonia' (31%) and suspected sepsis (9%). Twenty-three per cent had no documented reason. In patients started on intravenous antibiotics, only 32% (14) had the medication discontinued once RSV infection was confirmed. Of the remaining 30 patients, 10 had positive blood (16.6%) or urine (16.6%) cultures, and 15 (50%) had no clearly defined bacterial etiology or rationale documented. Eighty-eight per cent of patients who received ribavirin also received an antibiotic compared with 55% of patients who did not receive ribavirin (P<0.005). The total medication cost of the administered antibiotics was CDN$4,578.16. Eleven adverse events were recorded in children given antibiotics, of which 10 (91%) were in those receiving intravenous preparations.
This study demonstrated that a high percentage of children admitted to hospital with LRI secondary to RSV received antibiotics in the absence of a clearly defined bacterial coinfection. Physician education strategies should stress discontinuation of antibiotic therapy once RSV infection is diagnosed. This may diminish the development of resistant bacteria, reduce health care costs and minimize the potential for adverse events associated with inappropriate antibiotic use.
确定一组因呼吸道合胞病毒（RSV）继发下呼吸道感染（LRI）的儿童使用抗生素的范围、理由及购置成本。
前瞻性观察队列研究。
入住三级儿科医院、临床诊断为LRI且呼吸道合胞病毒直接免疫荧光显微镜检查和/或病毒培养呈阳性的两岁以下患儿符合入选标准。患有潜在心脏异常、呼吸系统疾病或免疫抑制的两岁以上患儿也符合入选标准。这些患儿作为加拿大儿科感染研究协作网络（PICNIC）RSV相关LRI研究的一部分被纳入。
1993年1月1日至4月30日期间共纳入152例患儿。中位年龄为5.6个月（范围0.2至151个月）；男女比例为1.6:1。发病率与先前报道的队列相当，无患儿死亡。67例（44%）患儿在住院前接受了抗生素治疗，92例（60.5%）患儿在住院期间至少接受了一种抗生素治疗。在住院期间接受抗生素治疗的患儿中，65例给予口服制剂，44例给予静脉制剂。住院期间抗生素处方的原因包括中耳炎（37%）、“肺炎”（31%）和疑似败血症（9%）。23%的患儿无记录在案的原因。在开始使用静脉抗生素的患儿中，一旦确诊RSV感染，只有32%（14例）停用了该药物。在其余30例患儿中，10例血培养（16.6%）或尿培养（16.6%）呈阳性，15例（50%）没有明确的细菌病因或理由记录在案。接受利巴韦林治疗的患儿中有88%也接受了抗生素治疗，而未接受利巴韦林治疗的患儿中这一比例为55%（P<0.005）。所使用抗生素的总药物成本为4578.16加元。接受抗生素治疗的患儿中有11例记录了不良事件，其中10例（91%）发生在接受静脉制剂治疗的患儿中。
本研究表明，因RSV继发LRI入院的患儿中，很大一部分在没有明确细菌合并感染的情况下接受了抗生素治疗。医生教育策略应强调一旦诊断出RSV感染就停止抗生素治疗。这可能会减少耐药菌的产生，降低医疗成本，并将与不当使用抗生素相关的不良事件风险降至最低。
