Introduction Acute wheeze in pre-school children is a common paediatric presentation which is usually secondary to viral illness. One of the most common and challenging situations faced by the paediatrician is whether the child also requires empirical antibiotics to cover the risk of concurrent bacterial infection. Recent studies have suggested a role for antibiotics in the management of preschool wheeze in reducing duration of episodes.¹ However, antibiotics can increase microbial resistance and alter the host microbiome.

Objective To evaluate the role of antibiotics in reducing duration of episodes and readmission rates for wheeze in preschool children.

Design Retrospective analysis of wheeze presentations in preschool children requiring hospital admission over a one year period. Those children receiving antibiotics were compared to those who did not. Outcome measures included length of stay, number of oxygen days and long term readmission rates. Virology and chest radiograph data was also collected.

Results 673 cases of children (aged 1–5, 64% male) receiving inpatient management for wheeze were analysed. All patients received bronchodilators. Patients receiving antibiotics (n=64; 9.5%) were found to have a significantly increased length of inpatient stay and number of oxygen days (p=<0.0001; figure 1A & B) compared to children not receiving antibiotics (n=609; 90.5%). However, children in the antibiotic group were more likely to receive a chest radiograph (77% vs 11%, p<0.0001); although formal radiographic appearance was often non-specific. Virus isolation did not predict wheeze readmission rates since patients with a negative sample at presentation accounting for 46% of overall readmissions. Furthermore, there was no statistical difference in wheeze readmission rates 6–12 months after initial presentation (p=0.94) between the two groups (figure 1C).

• Download figure
• Open in new tab
• Download powerpoint

Abstract P85 Figure 1

Conclusions Early administration of antibiotics did not shorten disease course in our cohort but is correlated with prolonged inpatient stay and oxygen therapy. Furthermore, antibiotics prescribed at presentation in preschool children with wheeze do not reduce future episodes of wheeze requiring hospital admission.

Reference

1. Stokholm, et al. Lancet Resp Med2016;4:19–26.