Children hospitalized for dengue often given unnecessary antibiotics

Indonesia: Children hospitalized with dengue in private hospitals are often given unnecessary antibiotics for presumed concurrent bacterial infection -- is the bottom line of a recently published study in the journal PLoS Neglected Tropical Diseases. The findings call for the implementation of the antibiotics stewardship program, especially in private hospitals to decrease the inappropriate use of antibiotics.

Dengue is one of the leading causes of hospitalization among children in endemic areas. Clinical manifestations of dengue range from mild illness to severe and sometimes fatal illness. The unpredictable outcome leads both parents and physicians to hospitalize patients. In developing countries, due to the poor implementation of the antibiotics stewardship program, hospitalized patients are more prone to receive unnecessary antibiotics.

Riyadi Adrizain, Padjadjaran University in Indonesia, and colleagues evaluated whether antibiotics given to hospitalized children with dengue in two different hospital settings, teaching and private hospitals, were appropriate.

For the purpose, the researchers examined the prevalence, indication and choice of antibiotics administered to children aged younger than 15 years. They gathered patient and epidemiologic information using medical records of hospitalized patients who were admitted between Jan. 1 and Dec. 31, 2015, in the municipality of Bandung, Indonesia.

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Key findings of the study include:

• During the study period, 3,078 children with dengue were hospitalized, with 176 admitted to teaching hospitals and 2,902 admitted to private hospitals.


• 17.5% of all children hospitalized with dengue received antibiotics.


• In teaching hospitals, one child had presumed bacterial upper respiratory tract infection (URTI), and six children had typhoid coinfection.


• Private hospitals reported more bacterial coinfections, including presumed bacterial URTI (n = 324; 11.2%), typhoid (n = 188; 6.5%) and UTI (n = 18; 0.6%).


• The prevalence of bacterial coinfection was significantly lower in teaching hospitals for both URTI and typhoid.


• The researchers identified one patient in the teaching hospitals who received amoxicillin, whereas third-generation cephalosporins were given to 67% of cases in private hospitals. Most of the cephalosporins were given intravenously.


• All children diagnosed with typhoid while they were treated for dengue in teaching hospitals had confirmation with either culture (n = 1) or a reactive immunoglobulin M anti-Salmonella test (n = 5).


• Most children with dengue and typhoid who were treated in private hospitals did not have laboratory confirmation (60.6%; n = 114), but IgM anti-Salmonella (6.5%; n = 13) and single Widal tests (32.5%; n = 61) were used for some patients.


• Most children diagnosed with typhoid in both types of hospitals were treated with third-generation cephalosporins.


• Diagnoses for UTI were made using leucocyturia alone for most cases in private hospitals (61.1%; n = 11).


• The remaining patients with dengue who tested positive for UTI did so through a positive esterase and nitrate in urine dipstick test (38.9%; n = 7).


• Nearly all children with UTI were treated with third-generation cephalosporins (83.3%; n = 15), whereas amoxicillin, chloramphenicol and clarithromycin were each given to one child.

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"Both the indication and the choice of antibiotics in hospitalized children with dengue infection and presumed bacterial coinfection were inappropriate in most cases — especially in private hospitals," concluded the authors.

"Changing the way medical doctors use antibiotics is needed to greatly slow down the development and spread of antibiotic-resistant bacteria,” they wrote.

To read the complete study follow the link: https://doi.org/10.1371/journal.pntd.0007438