Young children treated for bronchiolitis in emergency departments (EDs) commonly are
prescribed antibiotics despite not having a bacterial infection, a recent study found.
Bronchiolitis is the most common lower respiratory tract infection among children
under 2 years. In its 2014 guidelines, the Academy said antibiotics should not be
used unless there is evidence of a bacterial infection. Improper prescribing can lead
to antibiotic resistance, potential for adverse events and higher health care costs,
the Academy says in the Choosing Wisely campaign.
To look at whether these recommendations are being followed, researchers analyzed
nationally representative data from 2007-’15 National Hospital Ambulatory Medical
Among their sample of 612 children under age 2 treated for bronchiolitis in an ED,
12% also had a bacterial infection, most commonly acute otitis media.
About 26% of patients received antibiotics while 70% of these children did not have
a bacterial infection. Prescribing rates did not change significantly over the nine
years of the study.
The most commonly prescribed antibiotics were penicillin and macrolides, even though
the latter typically aren’t recommended for children under 2.
Children were more likely to be prescribed antibiotics if they were treated at a non-pediatric
or non-teaching hospital, the study found.
AAP bronchiolitis guidelines also recommend against routine use of radiography, but
46% of children in the study underwent these tests and they were more likely to be
“Targeted interventions to reduce inappropriate prescribing among clinicians are essential,”
senior author Brett Burstein, M.D., Ph.D., M.P.H., said in a news release. “But at
the same time, informing the lay public about the potential downstream consequences
and why it is important not to overtreat viral conditions are equally important.”