Shen Yi-Jung, Lien Chia-En, Chou Yiing-Jenq, Huang Nicole, Tsai Theodore
Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts.
Am J Trop Med Hyg. 2025 May 27;113(2):347-352. doi: 10.4269/ajtmh.24-0414. Print 2025 Aug 6.
Nonspecific dengue clinical manifestations lead to avoidable antibiotic use. We describe antibiotic use in confirmed pediatric dengue cases and associated healthcare utilization and medical costs, including from antibiotic-associated adverse drug events (ADEs). From Taiwanese national administrative databases, children with confirmed dengue between 2009 and 2015 who were younger than 18 years old, without bacterial infection, and who were prescribed antibiotics a week before or after laboratory diagnosis were propensity score matched and compared with nonrecipients, using regression models for ADEs and medical care expenditures. A total of 1,959 out of 6,938 children (28.2%) with confirmed dengue without bacterial infection received antibiotics. Recipients were more likely to incur emergency department visits (odds ratio [OR]: 3.16; 95% CI: 2.62-3.81), hospitalizations (OR: 4.20; 95% CI: 3.48-5.07), and higher predicted medical care expenditures (new Taiwan dollar [NTD] $16,914 versus NTD $14,104) in a 30-day follow-up period. They also had significantly higher odds of overall defined (OR: 1.72; 95% CI: 1.42-2.09), dermatologic-related (OR: 1.83; 95% CI: 1.36-2.46), and gastrointestinal-related (OR: 1.67; 95% CI: 1.31-2.12) ADEs. A substantial proportion of pediatric patients with dengue received potentially avoidable courses of antibiotics. Recipients were more likely to experience ADEs, incurring more medical care utilization and expenditures than untreated cases.
登革热的非特异性临床表现导致了不必要的抗生素使用。我们描述了确诊的儿童登革热病例中的抗生素使用情况以及相关的医疗保健利用和医疗费用，包括抗生素相关的药物不良事件（ADEs）。利用台湾地区国家行政数据库，对2009年至2015年确诊的18岁以下登革热儿童进行研究，这些儿童无细菌感染，且在实验室诊断前一周或后接受了抗生素处方，并通过倾向得分匹配法与未接受抗生素治疗的儿童进行比较，使用回归模型分析药物不良事件和医疗费用支出情况。在6938例确诊且无细菌感染的登革热儿童中，共有1959例（28.2%）接受了抗生素治疗。在30天的随访期内，接受抗生素治疗的儿童更有可能前往急诊科就诊（优势比[OR]：3.16；95%置信区间：2.62 - 3.81）、住院（OR：4.20；95%置信区间：3.48 - 5.07），且预测的医疗费用更高（新台币16,914元对新台币14,104元）。他们出现总体明确的药物不良事件（OR：1.72；95%置信区间：1.42 - 2.09）、皮肤相关药物不良事件（OR：1.83；95%置信区间：1.36 - 2.46）和胃肠道相关药物不良事件（OR：1.67；95%置信区间：1.31 - 2.12）的几率也显著更高。相当一部分儿童登革热患者接受了可能不必要的抗生素疗程。与未接受治疗的病例相比，接受抗生素治疗的患者更有可能发生药物不良事件，导致更多的医疗保健利用和费用支出。
