The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe
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 varice...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-019-7071-z |
| _version_ | 1818137187643817984 |
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| author | Lara J. Wolfson Marìa Esther Castillo Norberto Giglio Zsófia Mészner Zsuzsanna Molnár Mirella Vàzquez Jacek Wysocki Alexandra Altland Barbara J. Kuter Melissa Stutz Emmanouil Rampakakis Craig S. Roberts |
| author_facet | Lara J. Wolfson Marìa Esther Castillo Norberto Giglio Zsófia Mészner Zsuzsanna Molnár Mirella Vàzquez Jacek Wysocki Alexandra Altland Barbara J. Kuter Melissa Stutz Emmanouil Rampakakis Craig S. Roberts |
| author_sort | Lara J. Wolfson |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T09:52:19Z |
| format | Article |
| id | doaj.art-586a24ca5fe64ee2883dd32fa81d4937 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-11T09:52:19Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-586a24ca5fe64ee2883dd32fa81d49372022-12-22T01:12:22ZengBMCBMC Public Health1471-24582019-06-0119111110.1186/s12889-019-7071-zThe use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & EuropeLara J. Wolfson0Marìa Esther Castillo1Norberto Giglio2Zsófia Mészner3Zsuzsanna Molnár4Mirella Vàzquez5Jacek Wysocki6Alexandra Altland7Barbara J. Kuter8Melissa Stutz9Emmanouil Rampakakis10Craig S. Roberts11Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE)Instituto Nacional de Salud del Niño (INSN)Hospital de Niños Ricardo GutiérrezSt. László Hospital for Infectious Diseases, National Institute of Child HealthNational Center for EpidemiologyInstituto Nacional de PediatríaPoznan University of Medical SciencesMerck & Co., Inc., Center for Observational and Real-World Evidence (CORE)Merck & Co., Inc., Global Vaccines Medical AffairsJSS Medical ResearchJSS Medical ResearchMerck & Co., Inc., Center for Observational and Real-World Evidence (CORE)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.http://link.springer.com/article/10.1186/s12889-019-7071-zVaricellaPediatricsAntimicrobial stewardshipObservation study |
| spellingShingle | Lara J. Wolfson Marìa Esther Castillo Norberto Giglio Zsófia Mészner Zsuzsanna Molnár Mirella Vàzquez Jacek Wysocki Alexandra Altland Barbara J. Kuter Melissa Stutz Emmanouil Rampakakis Craig S. Roberts 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 Varicella Pediatrics Antimicrobial stewardship Observation study |
| title | The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe |
| title_full | The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe |
| title_fullStr | The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe |
| title_full_unstemmed | The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe |
| title_short | The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe |
| title_sort | use of antibiotics in the treatment of pediatric varicella patients real world evidence from the multi country marvel study in latin america europe |
| topic | Varicella Pediatrics Antimicrobial stewardship Observation study |
| url | http://link.springer.com/article/10.1186/s12889-019-7071-z |
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