Background: Children with acute respiratory tract infection (ARTI) represent an important target group for efforts aimed at reducing unnecessary antibiotic use.
Objective: To present the epidemiological data and evaluate the effect of clinical, laboratory, radiological and microbiological data on the decision to prescribe antibiotics to pediatric patients with ARTI as well as to seek criteria that would justify antibiotic use.
Patients and methods: A retrospective review was made of the clinical histories of 147 previously healthy children, consecutively admitted to our hospital with ARTI for 1 year (May 1996-April 1997). Patients were divided in two groups: those not treated with antibiotics (n = 92) and those treated (n = 55). Data from the two groups were compared with a statistical computer program (R-Sigma).
Results: Of the 147 patients studied, mean age was 2.5 years (range 0-14 years) and 85 (58%) males. One-hundred-and-five patients (72%) had previously been attended to in the emergency room, and 45 patients (30%) had been treated with antibiotics. Upper respiratory tract infection was diagnosed in 81 patients (54%), bronchitis in 28 (18%), bronchiolitis in 23 (15%) and pneumonia in 15 (10%). Ninety-seven patients (66%) had viral infection and only two (1%) had bacterial infection. Syncytial respiratory virus was isolated in 41 patients (28%) and adenovirus in 30 (20%). In the untreated group, the longer duration of symptoms before admission, lymphocytosis, clinical diagnosis of bronchiolitis and normal thorax X-ray, were statistically significant. In the treated group, fever, leukocytosis, neutrophilia and a diagnosis of pneumonia were statistically significant. Length of stay was longer in this group than in the untreated group.
Conclusions: It is difficult to prescribe antibiotics on the basis of bacteriologic data. Laboratory, analytic and radiological data can be helpful in the rational use of antibiotics.