Antibiotic prescription in pediatric patients with influenza in outpatient and emergency departments: A cross-sectional study

Background: Influenza 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. Methods: We 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. Results: The 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. Conclusions: Our findings highlight baseline antibiotic prescribing in children with influenza and predictors of prescribing behaviors to enhance further antibiotic stewardship programs. (c) 2025 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).