Antibiotic Use in Pediatric Dengue Cases in Taiwan: A National Administrative Database Analysis

Nonspecific dengue clinical manifestations lead to avoidable antibiotic use. We describe antibiotic use in confirmed pediatric dengue cases and associated healthcare utilization and medical costs, including from antibiotic-associated adverse drug events (ADEs). From Taiwanese national administrative databases, children with confirmed dengue between 2009 and 2015 who were younger than 18 years old, without bacterial infection, and who were prescribed antibiotics a week before or after laboratory diagnosis were propensity score matched and compared with nonrecipients, using regression models for ADEs and medical care expenditures. A total of 1,959 out of 6,938 children (28.2%) with confirmed dengue without bacterial infection received antibiotics. Recipients were more likely to incur emergency department visits (odds ratio [OR]: 3.16; 95% CI: 2.62-3.81), hospitalizations (OR: 4.20; 95% CI: 3.48-5.07), and higher predicted medical care expenditures (new Taiwan dollar [NTD] $16,914 versus NTD $14,104) in a 30-day follow-up period. They also had significantly higher odds of overall defined (OR: 1.72; 95% CI: 1.42-2.09), dermatologic-related (OR: 1.83; 95% CI: 1.36-2.46), and gastrointestinal-related (OR: 1.67; 95% CI: 1.31-2.12) ADEs. A substantial proportion of pediatric patients with dengue received potentially avoidable courses of antibiotics. Recipients were more likely to experience ADEs, incurring more medical care utilization and expenditures than untreated cases.