This study attempts to address the question we've been asking ourselves since the dawn of antibiotics – does this child with a fever have a viral infection, or a bacterial infection? Of course, in reality, we should be asking a more complicated question – does this child have a viral infection, or a bacterial infection for which the increased likelihood of positive outcome with antibiotics outweighs the harms of the antibiotics? But, I digress.
One hypothesis that is bandied about in literature and practice is, if rapid viral testing were available in the Emergency Department, perhaps a positive viral test result would reduce the likelihood of antibiotic usage. These folks from Washington University performed viral PCR for a host of common viruses on 75 children with fever without a source, 15 children with probable bacterial infections, and 115 afebrile children presenting for outpatient surgery. The authors note the patients with bacterial infections were less likely to test positive for a virus – and suggest prospective trials might describe a strategy in which viral testing decreased antibiotic use.
In their cohort, 55% of children aged 2 to 12 months and 39% of those aged 13 to 24 months with no obvious source for fever received antibiotics. This is irresponsible lunacy. However, a much faster, cheaper way to decrease antibiotic use is: to simply return from the abyss of antibiotic overuse to a land of rational practice.
After all, 40% of the bacterial infections and 35% of the outpatient surgical patients tested positive for a virus – clearly indicating the presence of a virus has limited association with acute viral illness or absence of an acute bacterial infection. More tests are not the answer – at least, certainly not this battery of PCR tests.
"Detection of Viruses in Young Children With Fever Without an Apparent Source"