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Multicenter Study
. 2019 Mar;38(3):505-514.
doi: 10.1007/s10096-018-03454-2. Epub 2019 Feb 1.

Antibiotic misuse in respiratory tract infections in children and adults-a prospective, multicentre study (TAILORED Treatment)

Chantal B van Houten  1 , Asi Cohen  2 , Dan Engelhard  3 , John P Hays  4 , Roger Karlsson  5 , Edward Moore  5 , David Fernández  6 , Racheli Kreisberg  7 , Laurence V Collins  7 , Wouter de Waal  8 , Karin M de Winter-de Groot  9 , Tom F W Wolfs  1 , Pieter Meijers  10 , Bart Luijk  11 , Jan Jelrik Oosterheert  12 , Rik Heijligenberg  13 , Sanjay U C Sankatsing  14 , Aik W J Bossink  15 , Andrew Stubbs  16 , Michal Stein  17 , Sharon Reisfeld  17 , Adi Klein  17 , Ronit Rachmilevitch  17 , Jalal Ashkar  17 , Itzhak Braverman  17 , Valery Kartun  17 , Irena Chistyakov  18 , Ellen Bamberger  18 , Isaac Srugo  18 , Majed Odeh  18 , Elad Schiff  18 , Yaniv Dotan  19 , Olga Boico  2 , Roy Navon  2 , Tom Friedman  2 , Liat Etshtein  2 , Meital Paz  2 , Tanya M Gottlieb  2 , Ester Pri-Or  2 , Gali Kronenfeld  2 , Einav Simon  2 , Kfir Oved  2 , Eran Eden  2 , Louis J Bont  20
Affiliations
Multicenter Study

Antibiotic misuse in respiratory tract infections in children and adults-a prospective, multicentre study (TAILORED Treatment)

Chantal B van Houten et al. Eur J Clin Microbiol Infect Dis. 2019 Mar.

Abstract

Respiratory tract infections (RTI) are more commonly caused by viral pathogens in children than in adults. Surprisingly, little is known about antibiotic use in children as compared to adults with RTI. This prospective study aimed to determine antibiotic misuse in children and adults with RTI, using an expert panel reference standard, in order to prioritise the target age population for antibiotic stewardship interventions. We recruited children and adults who presented at the emergency department or were hospitalised with clinical presentation of RTI in The Netherlands and Israel. A panel of three experienced physicians adjudicated a reference standard diagnosis (i.e. bacterial or viral infection) for all the patients using all available clinical and laboratory information, including a 28-day follow-up assessment. The cohort included 284 children and 232 adults with RTI (median age, 1.3 years and 64.5 years, respectively). The proportion of viral infections was larger in children than in adults (209(74%) versus 89(38%), p < 0.001). In case of viral RTI, antibiotics were prescribed (i.e. overuse) less frequently in children than in adults (77/209 (37%) versus 74/89 (83%), p < 0.001). One (1%) child and three (2%) adults with bacterial infection were not treated with antibiotics (i.e. underuse); all were mild cases. This international, prospective study confirms major antibiotic overuse in patients with RTI. Viral infection is more common in children, but antibiotic overuse is more frequent in adults with viral RTI. Together, these findings support the need for effective interventions to decrease antibiotic overuse in RTI patients of all ages.

Keywords: Antibiotic use; Infectious diseases; Pulmonology; Respiratory tract infections.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of patients AB− antibiotics not prescribed, AB+ antibiotics prescribed, RTI respiratory tract infection, AAU appropriate antibiotic use, IAU inappropriate antibiotic use
See this image and copyright information in PMC

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