Antibiotic Use in Paediatric Patients Hospitalized with Acute Severe Asthma

Abstract

Background Antibiotic use during asthma exacerbations in paediatric patients is not routinely recommended but common practise in out-patient and in-patient settings. Objective of this study was to analyse frequency of antibiotic use during acute severe asthma exacerbations, antibiotic classes utilized and clinical decision-making.

Methods All in-patient admissions over 10 years in a single German Children’s University hospital due to acute severe asthma were included in this retrospective analysis. Age, length of stay, oxygen supplementation, treatment, laboratory parameters and chest x-rays of all patients ranging from 1 to 17 years were analysed.

Results 580 hospital admissions were included in this study. Overall antibiotic use was high but decreased with age (1–5 years 69,6%, 6–11 years 57,6% and 12–17 years 39,7%, p<0.001). Analysis of antibiotic treatment without clear indication showed a consistently lower treatment rate of 28.3%, with macrolides being the most common antibiotic class. Younger age significantly decreased, whereas, increase of CrP value, use of oxygen supplementation and concomitant fever all significantly increased the odds ratio (OR 0.967; 4.366, 2.472 and 2.011 respectively) of receiving antibiotic treatment without clear indication.

Conclusion Antibiotic treatment without clear indication during acute severe asthma is common in this German single-centre cohort. Clinical parameters of more severe disease affect clinician’s decision to administer antibiotics despite evidence of bacterial infection or improved outcome.

Zusammenfassung

Hintergrund Der Einsatz von Antibiotika bei Asthma-Exazerbationen bei pädiatrischen Patienten wird nicht routinemäßig empfohlen, ist aber in der ambulanten und stationären Versorgung gängige Praxis. Ziel dieser Studie war es, die Häufigkeit des Antibiotikagebrauchs während akuter, schwerer Asthma-Exazerbationen, die verwendeten Antibiotikaklassen und die klinische Entscheidungsfindung zu analysieren.

Methoden In diese retrospektive Analyse wurden alle stationären Aufnahmen über 10 Jahre in einer deutschen Universitätskinderklinik wegen akutem, schweren Asthma eingeschlossen. Analysiert wurden Alter, Aufenthaltsdauer, Sauerstoffbedarf, Behandlung, Laborparameter und Röntgenthorax aller Patienten im Alter von 1 bis 17 Jahren.

Ergebnisse 580 Krankenhausaufenthalte wurden in diese Studie eingeschlossen. Der Antibiotikagebrauch war insgesamt hoch, nahm aber mit zunehmendem Alter ab (1–5 Jahre 69,6%, 6–11 Jahre 57,6% und 12–17 Jahre 39,7%, p<0,001). Die Analyse der Antibiotikatherapie ohne eindeutige Indikation zeigte eine niedrigere Behandlungsrate von 28,3%, wobei Makrolide die häufigste Antibiotikaklasse waren. Ein jüngeres Alter, ein Anstieg des CrP-Wertes, die Gabe von Sauerstoff und begleitendes Fieber erhöhten alle signifikant die Odds Ratio (OR 0,967; 4,366, 2,472 bzw. 2,011) für eine Antibiotika-Behandlung ohne klare Indikation.

Schlussfolgerung Eine Antibiotikatherapie ohne eindeutige Indikation bei akutem, schweren Asthma ist in dieser deutschen Kohorte häufig. Klinische Parameter einer schwereren Erkrankung beeinflussen die Entscheidung des ärztlichen Personals, Antibiotika trotz fehlender Anzeichen einer bakteriellen Infektion und fehlender Evidenz für ein verbessertes Outcome zu verabreichen.

Key words

Asthma - antibiotics - acute asthma - pediatric asthma

Schlüsselwörter

Asthma - Antibiotika - Akutes Asthma - Pädiatrisches Asthma

Publication History

Article published online:
21 March 2022

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