Acute Respiratory Infections in Children during Coronavirus Disease 2019: Without Reverse Transcriptase-Polymerase Chain Reaction Test and With Risk of Over-Prescription of Antibiotics, the Perfect Storm

Preliminary evidence suggests that children are as likely as adults to become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that produces coronavirus disease 2019 (COVID-19), with a frequency of cases of 1.7% to 2%, and with more benign symptomatology. Most children present with fever and cough, with infections in the upper respiratory tract, and they not likely to require hospitalization. Thus, COVID-19 disease is frequently presented to the pediatrician or general practitioner as an Acute Respiratory Infection (ARI), which is the most common type of infection in the world. So, at present, the SARS-CoV-2 virus is one more aetiological agent of ARI. At present, and as with adults, a confirmed case of COVID-19 in children requires a positive reverse transcriptase-polymerase chain reaction test for SARS-CoV-2. However, the reality is that there is a lack or limited capacity of tests in many places. Thus, the doctor may feel the urge to prescribe antibiotics for ARI in children, without sufficiently considering the consequences of inappropriate treatments. Despite antibiotics are not recommended for treating uncomplicated ARI, antibiotic prescribing is widespread. Also, telemedicine visits that are frequent during COVID-19 outbreak, may Increase even more antibiotic overprescribing. COVID-19 antibiotics are reserved for patients suspected of having concomitant bacterial or fungal infections. But, in practice, Azithromycin (AZM) tends to be empirically prescribed, since among other effects it seems to inhibit viral replication, and is subject to studies. However, there is still little scientific evidence to support its administration, and the consequences of inadequate prescription of antibiotics should be considered. In paediatrics patients, prudent and judicious use of antibiotics, including AZM, for ARI, is even more necessary during the COVID-19 pandemic.


Jose Luis Turabian

Abstract | Full-Text | PDF

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