Inappropriate antibiotic prescribing for acute bronchiolitis in Colombia: a predictive model

Abstract

ABSTRACT: Introduction: Acute bronchiolitis is the leading cause of hospitalization in the pediatric population. The inappropri ate prescription of antibiotics in acute bronchiolitis is associated with bacterial resistance, higher costs, and risk of adverse efects in this population. The objective of this work is to develop a predictive model of inappropriate use of antibiotics in children with acute bronchiolitis in Colombia. Methods: A retrospective cohort study was conducted in patients under 2 years of age with a diagnosis of acute bronchiolitis from two hospitals in Rionegro, Colombia. To identify factors independently associated with inappropriate use of antibiotics, we used logistic regression and estimated odds ratios (ORs). To assess discrimination, area under the curve (AUC) was estimated with a 95% confdence interval and plotted using AUC–ROC plots. To correct sampling bias of variance parameters and to evaluate the internal validity of the model, repeated curved validation “tenfold cross-validation” was used, comparing the area under the ROC curve obtained in the repetitions with that observed in the model Results: A total of 415 patients were included. 142 patients (34.13%) had a prescription of some antibiotic during their hospital stay. In 92 patients (64.78%, 95% CI 56.3 to 72.6%) the prescription of antibiotics was classifed as inappropriate. Age older than 1 year, chest retractions, temperature between 37.5 °C and 38.5 °C and leukocyte count between 10,000 and 15,000 million/mm3 were the predictive variables of inappropriate use of medications in this population. Conclusion: The presence of fever between 37.5 °C and 38.5 °C, leukocytosis between 10,000 and 15,000 million/ mm3 , and age older than 1 year and presence of chest retractions, should alert the physician regarding the high risk of inappropriate prescription of antibiotics. Patients with acute bronchiolitis with a score on our scale greater than 2 should be carefully evaluated regarding the need for the use of antibiotics, if prescribed.