Viral studies reduce antibiotic use in hospitalized febrile infants | Image Credit: © John Doe - © John Doe - stock.adobe.com.

Published in Acta Paediatrica

How should a positive viral test result influence the management of young infants who have been hospitalized for fever? One proposal comes from a study in a single children’s hospital, where all febrile infants are admitted to a dedicated infectious diseases unit and are tested for respiratory viruses, herpes simplex virus, enterovirus, and parechovirus, then given 24 hours of antibiotic treatment if found to have a viral infection and no growth on bacterial culture. This new standard of care has been found to shorten the course of antibiotic treatment without delaying the diagnosis of bacterial infections.

The study group included 1696 febrile infants up to 8 weeks old who appeared healthy and had no signs of focal bacterial infection upon admission. Approximately half of the group was subject to the hospital’s new standard of care, and the other half (the baseline population) was not. Investigators reviewed outcomes in the baseline population retrospectively for 16 months before implementation of the new standard and the other group prospectively for 26 months. The 2 groups were similar in age and had similar white blood cell counts and C-reactive protein levels upon admission.

Implementation of the new standard of care was associated with a significant reduction in how long inpatients received antibiotic treatment, with no known delayed diagnosis of bacterial infections. Median antibiotic treatment duration decreased from 29.4 hours to 22.2 hours in these patients; however, the overall length of stay was similar in the group that was subject to the new standard of care and in the baseline group. Viruses identified in more than 20 patients in both study periods were rhino/enterovirus (found in 207 patients), followed by enteroviruses, respiratory syncytial virus, parechoviruses, seasonal coronaviruses, SARS-CoV-2, and human parainfluenza viruses.

Of the total study group encompassing the 2 time periods, 903 (53.2%) had negative viral test results, of whom 507 were admitted. In this group, antibiotic treatment duration fell from 31.6 hours to 26.2 hours.

Investigators noted that a 24-hour “rule out” appears to be safe in febrile infants with proven viral infection as no patients in this group were later diagnosed with a serious or invasive bacterial infection.

THOUGHTS FROM DR. FARBER

Whether to treat very young febrile children—and for how long—remains a complex issue. Testing for viruses should be the standard of care to help guide therapy. Even more impressive to me, but not highlighted in the article, is that many of these children were not admitted at all, presumably based on viral testing and clinical appearance.

Reference:

Erdem G, Watson JR, Tomatis C, Ceyhan K, Barson W. Impact of viral testing on duration of antibiotic treatment and hospitalisation of febrile infants. Acta Paediatr. 2025;114(1):116-121. doi:10.1111/apa.17413