70% Infants With Bronchiolitis Prescribed Antibiotics Inappropriately

Above is the title of an article which appeared in the January 30, 2019, issue of Specialty Medical Dialogs. The report was based upon a study published in the Journal of the Pediatric Infectious Diseases Society on January 17, 2019.

The Mayo Clinic website describes bronchiolitis by saying, "Bronchiolitis is a common lung infection in young children and infants. It causes inflammation and congestion in the small airways (bronchioles) of the lung. Bronchiolitis is almost always caused by a virus." Recommended medical treatment does not involve antibiotics unless there is a secondary bacterial infection. Medical care is focused primarily to help if breathing is significantly hampered by the condition.

Antibiotics are used to treat bacterial infections and have no effect on viruses. In fact, they may be harmful to the child. An article in Medical News Today from 2011 stated the threat by saying, "Did you know that taking antibiotics when you or your child has a virus may do more harm than good? According to the US Centers for Disease Control and Prevention, where children are concerned, antibiotics are the most common cause of emergency department visits for adverse drug events."

The inappropriate use of antibiotics has been well documented over the years. However, this most recent study suggests that the warnings have still gone unheeded. An article in Healio Pediatrics on this new study gave an overview of the findings by saying, "A quarter of children aged younger than 2 years with bronchiolitis who visited U.S. EDs between 2007 and 2015 received antibiotics, even though 70% of those patients had no bacterial coinfection."

In the Healio article, Brett Burstein, MD, PhD, MPH, FRCPC, FAAP, and one of the study coauthors, commented on the study in Infectious Diseases in Children: "Bronchiolitis is a viral infection that does not respond to or require antibiotic treatment, and guidelines of the AAP (American Academy of Pediatrics), first published in 2006 and reiterated in 2014, recommend against the use of antibiotics for this illness. He continued, "Also, since 2013, reducing antibiotic prescribing for viral respiratory illness, including bronchiolitis, has become the top priority of the AAP’s Choosing Wisely national campaign. Despite these recommendations, we found that rates of antibiotic use did not decrease significantly in the decade following the guidelines."

The Healio article concluded with, "So, in addition to overprescribing, inappropriate antibiotic selection must be addressed," Burstein said. "Targeted interventions are necessary to translate these guidelines into practice, particularly among nonacademic hospitals, where most infants with bronchiolitis are evaluated and where the use of antibiotics was found to be higher."