Impact of antibiotic stewardship strategy on the outcome of non-critical hospitalized children with suspected viral infection

Abstract

Background

Viral fever is very common even among hospitalized patients in paediatrics. Often, antibiotics are unnecessarily prescribed leading to antibiotic misuse. In non-critical children, it is prudent to wait for clinical pattern to emerge before starting antibiotics even in hospitalized patients.

Aim

To study the clinical outcome in non-critical hospitalized children with suspected viral infections and to study the impact of antibiotic stewardship program in the institute.

Method

It was a prospective observational study carried out from November 2014 to August 2015 in the paediatric ward of Shardaben hospital affiliated to NHL Medical College. All non-critical hospitalized children with suspected viral infections fulfilling pre-defined criteria were included in the study. Patients with prolonged fever >7 days duration were excluded. The clinical course in ward of these patients was noted along with signs of improvement/deterioration. The antibiotic usage in ward over a period of 3 years before and after the implementation of antibiotic stewardship program was compared.

Results

Of all admitted patients, 1760 (56%) had suspected viral infection not requiring antibiotics on admission. Maximum patients were in 1–5 year age group. 4.6% turned out to be nonviral–bacterial infection/malaria and they required specific treatment. 56% of the study population required 1–3 days hospitalization. None of the patients required PICU admission and there was no mortality. The antibiotic usage reduced from 3.9 vials/admission to 2.36 vials/admission from 2011–12 to 2014–15.

Conclusion

Fever due to viral infections is very common even among non-critical hospitalized children. It is prudent to wait before starting antibiotics in such patients – it does not worsen the outcome. This study generates evidence for rational use of antimicrobials in paediatric practice. A protocol based ‘Antibiotic Stewardship Program’ can help in rationalizing antibiotic usage in selected group of patients.