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. 2024 Jan 8;13(1):64.
doi: 10.3390/antibiotics13010064.

Characterization of Antibiotic Treatment among Children Aged 0-59 Months Hospitalized for Acute Bacterial Gastroenteritis in Israel

Muna Omar  1 , Eias Kassem  2 , Roula Abu-Jabal  1 , Basher Mwassi  2 , Dani Cohen  1 , Khitam Muhsen  1
Affiliations

Characterization of Antibiotic Treatment among Children Aged 0-59 Months Hospitalized for Acute Bacterial Gastroenteritis in Israel

Muna Omar et al. Antibiotics (Basel). .

Abstract

Background: We examined the extent and correlates of appropriate antibiotic use among children hospitalized with bacterial acute gastroenteritis (AGE) in Israel, a high-income country setting.

Methods: Data were collected from children aged 0-59 months who participated in active hospital-based surveillance of AGE undertaken during 2007-2015. Bacterial AGE was defined as having a positive stool culture for Salmonella, Shigella, Campylobacter, or dysentery. Appropriate antibiotic use was defined as the administration of ciprofloxacin, azithromycin, or third-generation cephalosporins during hospitalization or at discharge.

Results: Overall, 550 children had bacterial AGE; of those, 369 (67.1% [95% CI 63.1-70.9]) received antibiotics, mostly azithromycin (61.8%) and third-generation cephalosporins (37.9%). Appropriate antibiotic treatment was given to 318/550 (57.8% [95% CI 53.7-61.9]). Children aged 0-11 months vs. 24-49 months were more likely to receive appropriate antibiotic treatment (OR = 1.90 [95% CI 1.09-3.33]). Having dysentery (OR = 5.30 [95% CI 3.35-8.39]), performing blood culture (OR = 1.59 [95% CI 1.02-2.48]), and C-reactive protein (CRP) levels (OR = 1.01 [95% CI 1.01-1.02]) were positively associated with receiving appropriate antibiotic treatment.

Conclusions: Most children with bacterial AGE received appropriate antibiotic treatment, which correlated with young age, dysentery, CRP level, and performing blood culture, suggesting more severe illness, thus supporting the clinical decisions of physicians.

Keywords: antibiotics use; children; culture-proven bacterial gastroenteritis; dysentery; high-income country; hospitalization.

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Conflict of interest statement

The authors report that there are no competing interests to declare.

Figures

Figure 1
Figure 1
Flow chart of the study Culture-proven bacterial gastroenteritis: positive stool culture for Salmonella, Shigella, or Campylobacter. Likely bacterial infection: blood leukocyte count >15 K/µL, neutrophils level >10 K/µL and C-reactive protein >50 mg/L. Bacterial co-infection: such as pneumonia, urinary tract infection, otitis media, etc. AGE: acute gastroenteritis.
Figure 2
Figure 2
Study design and data collection. Data were collected in two phases. The first phase was a prospective study, hospital-based surveillance conducted during 2007–2015, and included parental interviews, review of medical records, and collection of stool samples, which were tested for culture and rotavirus antigen. The second phase was a retrospective study conducted during 2019–2023, in which complementary data relevant to the current study were obtained retrospectively via full medical chart review. CRP: C-reactive protein; CFS: Cerebral spinal fluid.
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Grants and funding

The original study was funded by the World Health Organization, Department of Immunization, Vaccination and Biologicals (V27-181-190) in the first year, and by the Israel National Institute for Health Policy and Research (grant 2011/154A) in the remaining years. External funding was not provided for this study.