Antibiotic over-administration in hospitalized infants with Adenovirus infection.

Background: Infection with Adenovirus in children may clinically resemble a bacterial infection in several aspects, including high and prolonged fever, and increased inflammation markers. We aimed to estimate the rate of antibiotics administration among hospitalized infants with Adenovirus infection and to evaluate its justification.

Methods: Included were hospitalized patients aged 2 months - 2 years who found positive for Adenovirus in PCR tests (Ct <36). Basic epidemiological and clinical features were retrieved retrospectively. A panel of three certified pediatricians examined each case to decide whether the antibiotic treatment was justified. Subsequently, the cases were divided into two groups - the group treated with antibiotics and the untreated group. The groups were compared in terms of the various parameters.

Results: Out of 183 children with Adenovirus, 92 (50.3%) were treated with antibiotics. Only 42.4% of the antibiotics prescribed were medically justified. Children treated with antibiotics had a higher level of fever (39.4±0.90 vs. 38.6±0.98 °C; P<0.001), their blood oxygen saturation was higher (96.7±4.4% vs. 92.9±7.7%; P=0.0003), they were less dyspneic, and their inflammatory markers were higher as compared to those who had not been treated with antibiotics.

Conclusions: Approximately half of hospitalized pediatric patients <2 years old who were found positive for Adenovirus infection were treated with antibiotics during hospitalization. Most of these treatments were found retrospectively to be unjustified. Rapid and routine Adenovirus PCR testing can potentially reduce the rate of antibiotic treatment amongst hospitalized children.