BACKGROUNDInfluenza is a common viral respiratory infection, and inappropriate antibiotic use may lead to increased drug resistance and unnecessary waste of healthcare resources. However, real-world antibiotic prescribing in pediatric influenza patients remains largely unknown in China.METHODSWe performed a cross-sectional study of outpatient and emergency department prescriptions in a tertiary children's hospital for pediatric patients diagnosed with influenza between January 1, 2021, and July 31, 2023. The study outcome was mainly the rate and classes of antibiotic prescription in pediatric influenza patients, grouped by age group, C-reactive protein concentration, before and after the lifting of the non-pharmacological interventions, and location of the visit. Other outcomes, including risk factors for prescribing antibiotics, were analyzed by binary logistic regression.RESULTSThe analysis included 39,110 pediatric patients with influenza between 2021 and 2023, and the antibiotic prescription rate was 13.0 % (5067/39,110). After excluding influenza cases with concurrent bacterial infection diagnosis, the antibiotic prescription rate decreased to 11.7 % (4460/38,200). Of these, 93.2 % (4157/4460) received both antiviral and antibiotics. Macrolide antibiotics were the most frequently prescribed (49.2 %), followed by cephalosporins (35.2 %). We found that factors significantly associated with antibiotic prescriptions included male sex, ages ≥ 2 years, OPD visit, the period of low influenza virus activity, underlying diseases, co-infections, clinical diagnosis, and high C-reactive protein levels.CONCLUSIONSOur findings highlight baseline antibiotic prescribing in children with influenza and predictors of prescribing behaviors to enhance further antibiotic stewardship programs.

01 Apr 2025·Multiple Sclerosis and Related Disorders

Antibiotic drug use in the five years preceding the diagnosis of multiple sclerosis

Article

Author: Uibel, Paula Anne ; Hapfelmeier, Alexander ; Flaskamp, Martina ; Donnachie, Ewan ; Gasperi, Christiane ; Hemmer, Bernhard ; Darvishi, Sonia

BACKGROUNDMicrobiota may play a role in autoimmune disease pathogenesis, including multiple sclerosis (MS). Antibiotic use disrupts the microbiome and may increase the risk of autoimmune diseases. We evaluated the relationship between MS diagnosis and antibiotic, antimycotic and antiviral drug use in the 5 years preceding diagnosis.METHODOur population-based case-control study used German ambulatory claims data from 2012 to 2022. We defined cohorts of 13,053 MS patients, 22,898 Crohn's disease patients, and 15,037 matched controls without autoimmune diseases, aged 21-70. Logistic and Poisson regression models explored the relationship between MS diagnosis and antimicrobial usage. Two sub-analyses were performed: a separate analysis of patients with clinically isolated syndrome (CIS) and a sensitivity analysis of newly diagnosed MS patients without preceding neurological symptoms.RESULTSPatients with MS had higher exposure to antibiotic (Odd Ratio (OR) = 1.27, 95 % CI 1.21-1.33), antimycotic (OR = 1.27, 95 % CI 1.12-1.45), and antiviral drugs (OR = 1.28, 95 % CI 1.15-1.43) in the five years before diagnosis compared to patients with no autoimmune diseases. Similar findings were obtained for the CIS cohort and in the sensitivity analysis. Antibiotic use peaked 5 years before MS diagnosis, declining closer to diagnosis, while antiviral and antimycotic drug use showed the opposite. This effect was not observed in the sensitivity analysis and CIS cohorts. Antibiotic use was higher in Crohn's disease than in MS (OR = 0.86, 95 % CI 0.82-0.90), with no consistent differences in antimycotic and antiviral use.CONCLUSIONSThe association and kinetic of antibiotic use before MS and CIS diagnosis supports the role of microbiota in MS pathogenesis and suggests antibiotic use to be related to the development of autoimmune diseases, including MS. Additional studies are warranted to clarify whether increased antibiotic use is part of the MS prodrome or a true risk factor for MS.

01 Dec 2024·Science of The Total Environment

Screening potential biomarkers for acute respiratory infectious diseases from antipyretics, antiviral, and antibiotics in wastewater

Article

Author: Shao, Xue-Ting ; Wang, De-Gao ; Li, Hao-Yang ; Lin, Jian-Guo ; Gong, Zhen-Fang

Since the onset of COVID-19, respiratory diseases have emerged as a focal concern within the field of public health. This study aims to reveal the prevalence of acute respiratory infectious diseases by screening antipyretic, antiviral, and antibiotic biomarkers through wastewater analysis. Samples were collected over a seven-day period each year in 2022, 2023, and 2024 from a northern city in China, assessing the concentrations of two antipyretics (paracetamol and ibuprofen), one antiviral drug (oseltamivir), eleven antibiotics, and three pathogens (influenza A, influenza B, and Mycoplasma pneumoniae). The usage of most antipyretics and antibiotics was higher in 2023 and 2024, primarily due to the outbreak of COVID-19 in 2023 and the prevalence of influenza A, influenza B, and Mycoplasma pneumoniae in 2024. The prevalence assessed using antipyretics (2.68 %) and pathogens (2.70 %) demonstrated a high degree of consistency, whereas the prevalence estimated using antibiotics and antiviral drugs was only 0.53 % and 0.36 %, respectively. Antibiotics are generally used to treat a broad spectrum of bacterial infections rather than targeting a specific pathogen, so their presence in wastewater may not directly reflect the prevalence of a particular disease. In contrast, antipyretics and specific pathogens exhibit a stronger correlation, suggesting that they may serve as more reliable biomarkers than antiviral and antibiotic drugs. The research findings offer alternative biomarkers, such as antipyretics, aside from pathogens, for the assessment of acute respiratory infectious diseases.

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