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Antibiotics Often Inappropriately Prescribed for Bronchiolitis in ED

THURSDAY, Jan. 17, 2019 -- Most children younger than 2 years with bronchiolitis seen in U.S. emergency departments and prescribed antibiotics have no documented bacterial coinfection, according to a study published online Jan. 17 in the Journal of the Pediatric Infectious Diseases Society.

Jesse Papenburg, M.D., from McGill University in Montreal, and colleagues conducted a repeated cross-sectional analysis of emergency department data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2015. The study population included all children aged <2 years with a discharge diagnosis of bronchiolitis.

The researchers identified 59,921 unweighted emergency department visits by pediatric patients during 2007 to 2015; of these, 1.1 percent met the inclusion criteria, representing an estimated 2.92 million emergency department visits for bronchiolitis in children aged <2 years. Overall, 89.7 percent of all visits were emergency department discharges. In 11.9 percent of the cases, there was at least one additional diagnosis consistent with bacterial infection. The most frequent bacterial coinfection was acute otitis media (7.8 percent). About one-quarter of patients (25.6 percent) received antibiotics. Most of the infants (69.9 percent) who received antibiotic treatment had no documented concomitant bacterial infection. The most commonly prescribed classes of antibiotics were penicillins and macrolides (37.9 and 37.7 percent, respectively). The results were similar when analyses were restricted to patients with bronchiolitis who were discharged from the emergency department.

"Unnecessary and inappropriate antibiotic use for treating bronchiolitis is common in U.S. emergency departments," the authors write. "Multicomponent quality-improvement initiatives, particularly in nonteaching and nonpediatric hospitals, are needed."

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Posted: January 2019

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