The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe

BMC Public Health. 2019 Jun 26;19(1):826. doi: 10.1186/s12889-019-7071-z.

Abstract

Background: Varicella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation.

Methods: Pooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1-14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country.

Results: Four hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, β-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%.

Conclusions: High rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications.

Keywords: Antimicrobial stewardship; Observation study; Pediatrics; Varicella.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy
  • Bacterial Infections / microbiology
  • Chickenpox / drug therapy*
  • Chickenpox / epidemiology
  • Chickenpox / virology
  • Child
  • Child, Preschool
  • Clindamycin / therapeutic use
  • Delivery of Health Care / standards*
  • Drug Prescriptions / statistics & numerical data*
  • Europe / epidemiology
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Inpatients
  • Latin America / epidemiology
  • Male
  • Outpatients
  • Retrospective Studies
  • beta-Lactamases / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Clindamycin
  • beta-Lactamases