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Randomized Controlled Trial
. 2022 Mar 22;119(12):e2112410119.
doi: 10.1073/pnas.2112410119. Epub 2022 Mar 14.

Prevention of antimicrobial prescribing among infants following maternal vaccination against respiratory syncytial virus

Joseph A Lewnard  1   2   3 , Louis F Fries  4 , Iksung Cho  4 , Janice Chen  4 , Ramanan Laxminarayan  5   6
Affiliations
Randomized Controlled Trial

Prevention of antimicrobial prescribing among infants following maternal vaccination against respiratory syncytial virus

Joseph A Lewnard et al. Proc Natl Acad Sci U S A. .

Abstract

SignificanceStrategies to reduce consumption of antimicrobial drugs are needed to contain the growing burden of antimicrobial resistance. Respiratory syncytial virus (RSV) is a prominent cause of upper and lower respiratory tract infections, as a single agent and in conjunction with bacterial pathogens, and may thus contribute to the burden of both inappropriately treated viral infections and appropriately treated polymicrobial infections involving bacteria. In a double-blind, randomized, placebo-controlled trial, administering an RSV vaccine to pregnant mothers reduced antimicrobial prescribing among their infants by 12.9% over the first 3 mo of life. Our findings implicate RSV as an important contributor to antimicrobial exposure among infants and demonstrate that this exposure is preventable by use of effective maternal vaccines against RSV.

Keywords: antimicrobial prescribing; antimicrobial resistance; randomized controlled trial; respiratory syncytial virus; vaccination.

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Conflict of interest statement

Competing interest statement: J.A.L. discloses receipt of grants and honoraria from Pfizer unrelated to this research. L.F.F., I.C., and J.C. are employees of Novavax.

Figures

Fig. 1.
Fig. 1.
Incidence of new antimicrobial prescription courses among infants within the ITT population by setting and occurrence of a linked LRTI diagnosis. We present cumulative incidence curves for the denominator of all live-born infants within the ITT population and stratify data for all countries (A and B), HICs (C and D), and LMICs (E and F). Red and black lines indicate observations among infants whose mothers were randomized to the RSV F vaccine and placebo, respectively; Insets plot data throughout the first year of life. We further stratify by drug class in SI Appendix, Fig. S1 and present all-antimicrobial and drug-stratified observations among maternal participants in SI Appendix, Figs. S2 and S3.
Fig. 2.
Fig. 2.
Total antimicrobial prescribing averted by the RSV F vaccine among infants within the ITT population. We plot the number of antimicrobial prescription courses averted over each period as points with lines signifying 95% CIs, derived from primary effect estimates presented in Tables 2 and 3. Estimates are stratified for all prescribing and LRTI-associated prescribing by HIC or LMIC setting and by drug class.
See this image and copyright information in PMC

References

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