Suchitra Rao, MBBS, MSCS: Antibiotic Prescribing in Children


Why it may be more prudent for prescribing clinicians to assume viral, rather than bacterial, infection while awaiting test results in presenting pediatric cases.

Research from a pediatric emergency department (ED) setting showed a 12 percentage-point increase in antibiotic prescribing among children who tested negative for a virus on a rapid respiratory pathogen (RRP) test.

The findings, presented at IDWeek 2020 by Suchitra Rao, MBBS, MSCS, Associate Professor of the University of Colorado School of Medicine, supported a paradoxical finding that antibiotic prescribing is more likely in instances when RRP tests are administered, regardless of their results.

Now, Rao and colleagues are looking for means to explore better use and presence of antimicrobial stewardship in pediatric emergent settings. One idea, Rao told Contagion® during IDWeek, is the implementation of more stewardship educational materials, and guidances based on the general decision-making strategies of different care teams.

Rao also expressed interest in observing the same comparison—antibiotic prescribing in children given or not given RRP tests—with the addition of stewardship teams, as well as in instances when even faster test results are available.

“The good news is some of these newer molecule panels have excellent sensitivity and specificity,” she said. “So if the collection method is done in a reasonable way, then you can really rely on and trust that test.”

Rao also touched on the need limit antibiotic prescribing in patient populations—particularly compared with more at-risk populations.

“I think that the general thought when you’re dealing with someone over 65 with a lot of different medical comorbidities is that the risk of missing a bacterial infection has a huge impact,” Rao said. “And there’s often a trigger to pull on antibiotics in that group, and rightly so.”

In pediatrics, she noted, risk factors are different, and clinicians often have more time to make prescribing decisions. It actually may be more prudent in such cases when symptoms are not severe and the clinical setting is not acute, to assume a viral cause in a child, and make prescribing decisions based on test results.

Watch the full interview with Rao in the video above.

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