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Am Fam Physician. 2003;67(9):1988

Acute viral upper respiratory disease is the most frequent reason for hospitalization of infants and children in the United States. Respiratory syncytial virus (RSV), influenza A and B viruses, and parainfluenza viruses are common causes of upper respiratory illness. The inappropriate and frequent use of empiric antibiotic therapy in patients with viral infections has contributed to the increased prevalence of resistant bacteria. Tests for the rapid and accurate detection of respiratory viruses are now available. Byington and colleagues conducted a study to determine whether the availability of a rapid viral test would affect the use of antibiotics in infants and children hospitalized because of acute upper respiratory disease.

The study was a retrospective audit of the medical records of children who were admitted to a Utah pediatric hospital and underwent direct fluorescent assay testing for RSV; influenza A and B viruses; parainfluenza 1, 2, and 3 viruses; and adenovirus. The study was conducted during two consecutive winter seasons. The main outcome measure was the use of antibiotics in patients who had a positive or negative viral screen.

During the first winter, patients with a positive viral screen had significantly fewer days of intravenous or oral antibiotic therapy than those with a negative viral screen. Patients with a positive viral screen also were less likely to receive prescriptions for oral antibiotics when they were discharged from the hospital. During the second winter season, patients with a positive viral screen were significantly less likely to receive intravenous antibiotic therapy than patients with a positive viral screen who were admitted during the first season (26 versus 44 percent). Patients who had a negative viral screen were 2.3 times as likely to be treated with intravenous antibiotics than patients of the same age who had a positive viral screen. The viral assay was found to have high sensitivity and specificity: fewer than 1 percent of patients with a positive viral screen had a culture-confirmed bacterial infection.

The authors conclude that use of direct fluorescent assay testing to detect viral agents can reduce inappropriate use of antibiotics in infants and children with acute upper respiratory tract disease. They add that use of accurate rapid viral detection methods should be included in any plan that seeks to contain antimicrobial resistance.

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