Refining Clinical Guidelines for Bronchiolitis: Factors Contributing to the Use of Antibiotics. A Single Center Review in Cyprus

Background: Several evidence-based clinical guidelines for bronchiolitis discourage the use of antibiotics. It was identified that our center was using non-recommended evidence-based care for the treatment of bronchiolitis.

Objective: We aimed to gather and analyze data from our center on the trends of bronchiolitis management and on the factors that prompts physicians to prescribed antibiotics.

Methods: Retrospective observational study accomplished by reviewing charts of children less than 2 years with a discharge diagnosis of bronchiolitis from September 2018 to March 2019. The study included 76 infants and children between the age 0-24 months with discharge diagnosis of bronchiolitis. Patients were divided into two groups. Both groups were treated with inhaled bronchodilators. Group A did not receive any antibiotics and patients in Group B received antibiotics. Group A included 34 patients with mean age of 5.5 months. Group B included 42 patients, 8 patients were excluded due to documented diagnosis of bacterial pneumonia. Mean age of patients in group B 11.8 months.

Results: No statistical significant difference was observed in the length of hospital stay in two groups. (Group A, mean 3.18 Group B mean 3.68, p= 0.38).There was no significant difference between the two groups on the percentage of RSV/flu positive cases (Group A 14% vs Group B 12%) and percentage of CXR abnormalities (Group A 62.5% vs Group A 61.1%).There was a statistically significant difference between CRP values in two Groups (Group A CRP mean 8.39, Group B CRP mean 19.63 p=0.012).

Conclusions: Antibiotics do not change the clinical course in bronchiolitis.We plan to implement new evidence-based clinical practice guidelines for our center for the upcoming RSV season.CPR levels need to be interpreted with caution when treating children with bronchiolitis and not to be used alone as a predictor for a concomitant bacterial infection.