Antibiotic Use for Inpatient Bronchiolitis: Did National Guidelines Impact Practice at a Pediatric Hospital?

Abstract

BACKGROUND AND OBJECTIVES: Bronchiolitis is a common lower respiratory tract infection that affects infants and young children. Because of variability in physician practice, inpatient management varies among pediatricians. In 2014, the Canadian Pediatric Society published national guidelines aimed at standardizing the inpatient management of this illness, which included recommending against the need for antibiotics for most patients. The study objective was to evaluate antibiotic prescription and supportive investigations for inpatient management of bronchiolitis before and after the publication of national guidelines. METHODS: This study was a single-center retrospective chart review of inpatients with bronchiolitis. We included healthy children 1 to 24 months of age who were admitted from November 2011 to October 2016. Those admitted before December 2014 were analyzed in the preguidelines cohort; the remaining, in the postguidelines cohort. The main outcome was antibiotic prescription. The secondary outcome was the frequency of chest radiographs, nasopharyngeal swabs, and blood cultures. RESULTS: A total of 131 patients were included in the first cohort; 71, in the second cohort. The rates of antibiotic initiation were almost equal in both cohorts (∼44%; P 5 .98). More antibiotics were discontinued during hospitalization in the second cohort compared with the first cohort (10% vs 20%; P 5 .001). Significantly fewer patients were discharged with antibiotics in the second cohort (31% vs 16%; P 5 .02). CONCLUSIONS: Our study revealed a reduction in antibiotic use after the release of national guidelines, illustrating that antibiotic prescribing practices can change. However, there is still a pressing need for local initiatives to continue to reduce the unnecessary use of antibiotics within the pediatric setting.

High prescribing rates of third-generation cephalosporins in children hospitalized with acute lower respiratory infections at a university hospital

“…Considering only the patients without co-morbidity, the median (IQR) LOS was 3 (2-5) days. This LOS is comparable to 1.6-3.3 days reported from the western countries in which patients with comorbidities or admitted to the ICU were excluded (Lopez et al, 2020, Milner et al, 2018, Parikh et al, 2017, Walls et al, 2017. The shortest LOS of 1.6 days reported from Wall et al (Walls et al, 2017) is probably due to the inclusion criteria.…”

Treatment for acute bronchiolitis before and after implementation of new national guidelines: a retrospective observational study from primary and secondary care in Oslo, Norway

“…24 25 Antibiotic treatment is not recommended for acute bronchiolitis, 9 26 27 and overuse is a known problem. [28][29][30] Our results showed a very low use of antibiotics, consistently below 5%, compared with other countries, where rates in the range of 3.5%-11.1% are reported. 28 We found a steady rise in the use of highflow oxygen in the hospital setting.…”

Impact of Guidelines Publication on Acute Bronchiolitis Management: 10-Year Experience from a Tertiary Care Center in Italy

“…In a study carried out in Canada to analyze the use of antibiotics in bronchiolitis before and after the national GL publication, it was found that the rates of antibiotic initiation were almost equal over time (about 44%). However, more antibiotics were discontinued during hospitalization and fewer patients were discharged with antibiotics in the post-GL group, illustrating that antibiotic prescribing practices can change [41]. Analyzing the impact of national GL in children hospitalized with bronchiolitis in public Portuguese hospitals, Fontoura-Matias et al showed only a modest improvement in management, including antibiotic prescription, with significant variation between regions [42].…”