Study of Outpatient Children in Five Waves of COVID-19: Comparing Clinical Manifestations, Need for Hospitalization, and Antibiotic Prescription

Background: The SARS-CoV-2 virus has shown various subtypes with unique characteristics, but the recurrence of COVID-19 in children and the use of antibiotics for secondary bacterial infections have not been thoroughly investigated. Objectives: This study aimed to analyze the frequency of COVID-19 infections in children and the prescription of antibiotics for secondary bacterial infections in pediatric outpatient cases. Methods: This cross-sectional study was conducted at three outpatient centers from February 2020 to August 2022. It included children under 15 years old with complete medical records related to SARS-CoV-2 infection. The study assessed clinical symptoms, hospitalization needs, antibiotic prescriptions, and the number of COVID-19 episodes. Results: Out of 2,448 children diagnosed with COVID-19, 65% were male. A total of 192 children (7.84%) had two episodes, 35 (1.43%) had three episodes, 7 (0.29%) had four episodes, and 2 (0.14%) had five episodes. 143 children (5.84%) required hospitalization. Antibiotics were prescribed in 17.73% of cases (n = 434), primarily for acute bacterial sinusitis (12.21%) and middle ear infections (8.52%). Common antibiotics included Azithromycin, Amoxicillin, Cefuroxime, and Co-trimoxazole. Conclusions: Different subtypes of SARS-CoV-2 display distinct clinical behaviors in the pediatric population. Children can contract COVID-19 multiple times; however, antibiotic use in outpatient settings is relatively low and mainly associated with specific conditions, such as acute sinusitis and middle ear infections.