Reviewed by Jose Lucar, MD, The George Washington University
Preventing respiratory syncytial virus (RSV) and influenza through immunization could substantially reduce unnecessary antibiotic use in children. In a retrospective analysis, King et al. examined U.S. pediatric outpatient antibiotic prescribing from 2008 to 2018 using insurance claims data from the Optum Clinformatics Data Mart. Over this period, more than 21.5 million outpatient antibiotic prescriptions were dispensed to children, with approximately two-thirds linked to diagnoses of acute respiratory infections. The study estimated that 6.3% of all pediatric antibiotic prescriptions were attributable to RSV, and 3.4% to influenza. RSV-associated prescribing was most prevalent among children under five years of age, while influenza-related prescribing was highest among children over five. Notably, macrolides were the antibiotic class for which RSV and influenza were associated with the greatest shares of prescriptions.
These findings suggest that RSV and influenza contribute meaningfully to pediatric antibiotic use, and preventive strategies may help reduce this burden. Maternal RSV vaccination during pregnancy and passive immunization of infants (e.g., with monoclonal antibodies like nirsevimab) offer promising approaches to protect the youngest children from RSV, with the potential to reduce both disease severity and antibiotic exposure. Similarly, annual influenza vaccination for children is an important public health intervention that could help lower the incidence of influenza-related illness and associated antibiotic prescribing. Improving vaccine uptake in these areas may support efforts to reduce unnecessary antibiotic use and slow the development of antibiotic resistance.
Reference:
King LM, Bruxvoort KJ, Tartof SY, Lewnard JA. Pediatric antibiotic use associated with respiratory syncytial virus and influenza in the United States, 2008-2018. J Infect Dis. Published online June 7, 2025. doi:10.1093/infdis/jiaf309