Clinical Report: Excessive Antibiotic Prescription for Viral Infections in Pediatric Patients

Overview

This study evaluates the frequency and predictors of antibiotic use in children hospitalized with SARS-CoV-2 in Switzerland, revealing that 30% received antibiotics despite limited evidence of bacterial infection. Key predictors include high-risk comorbidities and clinical suspicion of bacterial infection.

Background

Antibiotic overprescription in pediatric patients, particularly during the COVID-19 pandemic, raises concerns about antimicrobial resistance and adverse effects. Understanding the factors influencing antibiotic use in children with viral infections is crucial for improving antimicrobial stewardship. This study provides insights into the patterns of antibiotic prescribing in a pediatric population during a significant health crisis.

Data Highlights

Key Findings

• 30% of hospitalized children with SARS-CoV-2 received antibiotics.
• 12% had clinically suspected bacterial infections without microbiological confirmation.
• Predictors of antibiotic use included confirmed bacterial infection (aOR 138.08) and clinically suspected infection (aOR 114.48).
• Lower antibiotic use was associated with respiratory distress/tachypnoea (aOR 0.72) and confirmed SARS-CoV-2 as the primary diagnosis (aOR 0.42).
• After excluding high-risk patients, nasal symptoms (aOR 0.68) and seizures (aOR 0.34) emerged as protective factors.

Clinical Implications

The findings highlight the need for improved guidelines and practices regarding antibiotic use in pediatric patients with viral infections. Clinicians should be cautious in prescribing antibiotics and consider the clinical evidence of bacterial infections.

Conclusion

Antibiotics were frequently prescribed to children hospitalized with SARS-CoV-2, often without sufficient evidence of bacterial infection. Strengthening antimicrobial stewardship is essential in pediatric care.

Related Resources & Content

1. Open Forum Infectious Diseases, 2023 -- Trends in Antibiotic Use Among Adults Hospitalized for COVID-19 and Other Viral Respiratory Infections
2. The Journal of Infectious Diseases, 2023 -- Association of Pediatric Antibiotic Prescriptions with Respiratory Syncytial Virus and Influenza in the United States from 2008 to 2018
3. The Journal of Infectious Diseases, 2023 -- Hospitalizations for Pediatric Acute Respiratory Viruses: A Cohort Analysis from 2017 to 2024
4. IDSA Guidelines on the Treatment and Management of Patients with COVID-19, 2025
5. JAMA Network Open — Primary Care Telemedicine as an Antibiotic Stewardship and Environmental Solution
6. IDSA/PIDS 2026 Guidelines for the Management of Community-Acquired Pneumonia in Infants and Children
7. IDSA Guidelines on the Treatment and Management of Patients with COVID-19
8. Scaling an Evidence-Based Pediatric Antibiotic Stewardship Intervention: The Broad Implementation of Outpatient Stewardship (BIOS) Trial