Clinical Scorecard: Association of Pediatric Antibiotic Prescriptions with Respiratory Syncytial Virus and Influenza in the United States from 2008 to 2018
At a Glance
Category
Detail
Condition
Respiratory syncytial virus (RSV) and influenza infections contributing to pediatric antibiotic use
Key Mechanisms
RSV and influenza cause acute respiratory infections leading to outpatient antibiotic prescriptions due to diagnostic uncertainty, inappropriate prescribing, and treatment of bacterial co-infections
Target Population
Children aged 0–17 years with commercial insurance in the United States
Care Setting
Outpatient settings including doctors' offices and emergency departments
Key Highlights
An estimated 6.3% of pediatric outpatient antibiotic prescriptions were associated with RSV and 3.4% with influenza from 2008 to 2018.
RSV-associated antibiotic prescription incidence was highest among children aged ≤5 years; influenza-associated prescriptions were highest among children >5 years.
Macrolides were the antibiotic class most frequently prescribed in association with RSV and influenza infections.
Guideline-Based Recommendations
Diagnosis
Recognize that RSV and influenza contribute significantly to acute respiratory infections in children leading to antibiotic prescriptions.
Consider diagnostic uncertainty in outpatient ARIs as a driver of antibiotic use.
Management
Implement preventive measures including vaccination against influenza and RSV to reduce infection incidence and subsequent antibiotic use.
Avoid inappropriate antibiotic prescribing for viral infections to mitigate antimicrobial resistance.
Monitoring & Follow-up
Monitor outpatient antibiotic prescribing patterns in pediatric populations during RSV and influenza seasons.
Use time series analyses and surveillance data to assess the impact of viral circulation on antibiotic use.
Risks
Excessive antibiotic use driven by viral respiratory infections contributes to antimicrobial resistance.
Diagnostic uncertainty may lead to unnecessary antibiotic prescriptions.
Patient & Prescribing Data
Commercially insured US children aged 0–17 years from 2008 to 2018
RSV and influenza infections account for meaningful proportions of outpatient antibiotic prescriptions, particularly macrolides; vaccination strategies may reduce antibiotic use and resistance.
Clinical Best Practices
Promote vaccination against influenza and RSV in pediatric populations to reduce infection rates and antibiotic use.
Educate clinicians on distinguishing viral from bacterial infections to minimize inappropriate antibiotic prescribing.
Leverage surveillance and time series data to inform antibiotic stewardship interventions during peak viral seasons.
Investigative report cites internal communications, VAERS data, and CDC case reviews describing myocarditis and pericarditis reports in adolescents and young adults after mRNA COVID-19 vaccination.
A retrospective cohort study of more than 520,000 hospitalized patients found no clinically meaningful improvement in deterioration or mortality with early treatment targeting community-acquired pneumonia.
