Pediatric Antibiotic Prescriptions Associated with RSV and Influenza in US Children (2008–2018)
Overview
This retrospective study estimated that 6.3% of pediatric outpatient antibiotic prescriptions were associated with respiratory syncytial virus (RSV) and 3.4% with influenza among commercially insured US children from 2008 to 2018. RSV-associated antibiotic prescribing was highest in children aged ≤5 years, while influenza-associated prescribing predominated in children older than 5 years.
Background
Acute respiratory infections (ARIs) are a leading cause of outpatient antibiotic use in children, with RSV and influenza being common viral etiologies. These viral infections often lead to antibiotic prescriptions due to diagnostic uncertainty, inappropriate prescribing, or treatment of secondary bacterial infections. Quantifying the contribution of RSV and influenza to pediatric antibiotic use is challenging due to limited outpatient diagnostic testing and nonspecific clinical presentations. Understanding these contributions can inform vaccination strategies and antimicrobial stewardship efforts.
Data Highlights
Measure
Estimate (95% CI)
Proportion of antibiotic prescriptions associated with RSV
6.3% (5.2%–7.3%)
Proportion of antibiotic prescriptions associated with influenza
3.4% (3.1%–3.8%)
Annual RSV-associated antibiotic prescriptions per 1000 children
72.6 (59.7–85.9)
Annual influenza-associated antibiotic prescriptions per 1000 children
40.0 (35.1–45.1)
Key Findings
RSV accounted for a higher proportion of antibiotic prescriptions in children aged ≤5 years compared to older children.
Influenza-associated antibiotic prescriptions were more common in children older than 5 years.
Macrolides were the antibiotic class most frequently prescribed in association with RSV and influenza infections.
Overall, RSV and influenza together contributed to approximately 9.7% of pediatric outpatient antibiotic prescriptions.
Time series modeling using national claims and laboratory data enabled estimation of pathogen-attributable antibiotic use despite limited outpatient diagnostic testing.
Clinical Implications
Preventive measures such as vaccination against RSV and influenza in children may reduce unnecessary antibiotic prescribing and help combat antimicrobial resistance. Clinicians should be aware of the viral etiology of many pediatric ARIs to guide appropriate antibiotic use. Enhanced diagnostic strategies and stewardship interventions targeting these viral infections could further optimize antibiotic prescribing.
Conclusion
RSV and influenza infections are associated with meaningful proportions of pediatric outpatient antibiotic prescriptions in the United States. Immunization and preventive strategies targeting these viruses have the potential to reduce antibiotic use and mitigate antibiotic resistance.
References
Sullivan et al. 2023 -- Association of Pediatric Antibiotic Prescriptions with Respiratory Syncytial Virus and Influenza in the United States from 2008 to 2018
A large English cohort study found influenza hospitalization more than doubled the short-term risk of new-onset diabetes, with prediabetes and critical care admission among the strongest predictors.
