Background

Professional society guidelines recommend against routine early antibiotic use in the treatment of asthma exacerbation without comorbid bacterial infection. However, high antibiotic prescribing rates have been reported in developed countries.

Objective

We sought to assess the effectiveness of this strategy in the routine care of children.

Methods

Using data on 48,743 children hospitalized for asthma exacerbation with no indication of bacterial infection during the period 2010 to 2018, we conducted a retrospective cohort study to compare clinical outcomes and resource utilization between children who received early antibiotic treatment and those who did not.

Results

Overall, 19,866 children (41%) received early antibiotic treatment. According to the propensity score matching analysis, children with early antibiotic treatment had longer hospital stay (mean difference, 0.21 days; 95% CI, 0.18-0.28), higher hospitalization costs (mean difference, $83.5; 95% CI, 62.9-104.0), and higher risk of probiotic use (risk ratio, 2.01; 95% CI, 1.81-2.23) than children who did not receive early antibiotic therapy. Similar results were found from inverse probability of treatment weighting, g-computation, and instrumental variable methods and sensitivity analyses. The risks of mechanical ventilation and 30-day readmission were similar between the groups or slightly higher in the treated group, depending on the statistical models.

Conclusions

Antibiotic therapy may be associated with prolonged hospital stay, elevated hospitalization costs, and high risk of probiotic use without improving treatment failure and readmission. Our findings highlight the need for reducing inappropriate antibiotic use among children hospitalized for asthma.

中文翻译：

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哮喘急性发作住院儿童的早期抗生素治疗与临床结局之间的关联。

背景

专业协会指南建议不要在不加合并细菌感染的情况下，在哮喘急性发作中常规早期使用抗生素。但是，发达国家已经报告了较高的抗生素处方率。

目的

我们试图评估该策略在儿童常规照护中的有效性。

方法

我们使用2010年至2018年期间住院治疗的48,743名哮喘急性发作儿童的数据，没有细菌感染的迹象，我们进行了一项回顾性队列研究，比较了接受早期抗生素治疗的儿童与未接受早期抗生素治疗的儿童的临床结局和资源利用情况。

结果

总共有19,866名儿童（41％）接受了早期抗生素治疗。根据倾向得分匹配分析，早期抗生素治疗的儿童住院时间更长（平均差异为0.21天; 95％CI为0.18-0.28），住院费用更高（平均差异为83.5美元; 95％CI为62.9-104.0）与未接受早期抗生素治疗的儿童相比，使用益生菌的风险更高（风险比为2.01； 95％CI为1.81-2.23）。从治疗权重，g-计算，仪器变量方法和敏感性分析的逆概率中也发现了相似的结果。两组之间的机械通气和再次入院30天的风险相似，或在治疗组中略高，这取决于统计模型。

结论

抗生素治疗可能与住院时间延长，住院费用增加和使用益生菌的高风险而不改善治疗失败率和再入院率有关。我们的研究结果突显了减少住院哮喘儿童中不当使用抗生素的必要性。