Poole Nicole M, Moss Angela, Suresh Krithika, O'Leary Sean T, Rao Suchitra
Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, USA.
Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 N Revere Ct, 3rd Floor, Aurora, CO, 80045, USA.
Pediatr Res. 2025 Feb;97(2):634-638. doi: 10.1038/s41390-024-03418-7. Epub 2024 Jul 30.
Children with influenza-like-illness (ILI) often require clinician clearance or antibiotics to return to child care or school. Study objectives were to examine the association between antibiotic receipt during an Emergency Department (ED) visit for ILI and the outcomes of class absenteeism and illness duration.
A secondary analysis of 251 children aged 2 months to 12 years with uncomplicated ILI discharged from the ED from December 1, 2018 to November 30, 2019 was conducted. The primary exposure was receipt of antibiotics over the course of illness (assessed by chart review and family follow-up survey).
Patients prescribed antibiotics (n = 65) experienced a median of 3 (interquartile range [IQR]: 1,5) days of class missed and 5 (IQR: 3,7) days of illness compared to 2 (IQR: 1,4) days of class missed and 4 (IQR: 3,7) days of illness for those not prescribed antibiotics (n = 186, p = 0.08 and p = 0.13, respectively). There was no statistically significant association with missed class days (incidence rate ratio [IRR]: 1.14 [0.86-1.50], p = 0.37) or days of illness (IRR: 1.06 [0.88-1.27], p = 0.55) for patients prescribed antibiotics compared to patients not prescribed antibiotics for ILI.
Antibiotic use for ILI was not associated with reduced class absenteeism or illness duration.
Child care centers and schools sometimes exclude children with influenza-like-illness (ILI) from class until cleared to return by a clinician and/or prescribed antibiotics. This study addresses these social drivers of overprescribing. Antibiotics were prescribed in 26% of children with ILI discharged from a large Emergency Department in the US. Antibiotic use was not significantly associated with class absenteeism or illness duration. This study can serve as a discussion point for clinicians when navigating parental or social pressures to prescribe antibiotics for uncomplicated acute respiratory tract infections, particularly when these pressures are influenced by concerns about returning to class.
患有流感样疾病（ILI）的儿童通常需要临床医生批准或使用抗生素才能返回托儿所或学校。研究目的是探讨因ILI到急诊科就诊期间接受抗生素治疗与缺课天数和疾病持续时间之间的关联。
对2018年12月1日至2019年11月30日从急诊科出院的251名年龄在2个月至12岁之间、患有非复杂性ILI的儿童进行了二次分析。主要暴露因素是在疾病过程中接受抗生素治疗（通过病历审查和家庭随访调查评估）。
开具抗生素处方的患者（n = 65）缺课天数中位数为3天（四分位间距[IQR]：1,5），患病天数为5天（IQR：3,7）；而未开具抗生素处方的患者（n = 186）缺课天数中位数为2天（IQR：1,4），患病天数为4天（IQR：3,7）（分别为p = 0.08和p = 0.13）。与未开具抗生素处方的ILI患者相比，开具抗生素处方的患者在缺课天数（发病率比[IRR]：1.14 [0.86 - 1.50]，p = 0.37）或患病天数（IRR：1.06 [0.88 - 1.27]，p = 0.55）方面无统计学显著关联。
ILI使用抗生素与减少缺课天数或缩短疾病持续时间无关。
托儿所和学校有时会将患有流感样疾病（ILI）的儿童排除在课堂之外，直到临床医生批准其返回和/或开具抗生素处方。本研究探讨了过度开药的这些社会驱动因素。在美国一家大型急诊科出院的ILI儿童中，26%的儿童开具了抗生素处方。抗生素使用与缺课天数或疾病持续时间无显著关联。当临床医生应对为非复杂性急性呼吸道感染开具抗生素的家长或社会压力时，特别是当这些压力受返校担忧影响时，本研究可作为一个讨论要点。
