Antibiotic use attributable to RSV infections during infancy—an international prospective birth cohort study

Hak, SF; Venekamp, RP; Billard, M; Cianci, D; Van Houten, MA; Pollard, AJ; Heikkinen, T; Cunningham, S; Millar, M; Martinon-Torres, F; Dacosta-Urbieta, A; Bont, LJ; Wildenbeest, JG; the PROMISE Investigators

Journal article

Antibiotic use attributable to RSV infections during infancy—an international prospective birth cohort study

Abstract:: Background: Early-life antibiotic use impacts microbiome composition and contributes to the emergence of antimicrobial resistance. Despite respiratory syncytial virus (RSV) being a leading cause of acute respiratory infections (ARI), accurate estimates of antibiotic use attributable to RSV are lacking. Objectives: To assess RSV-associated antibiotic use during the first year of life. Patients and methods: The RESCEU birth cohort study followed healthy term infants, born (n = 9154) between 1 July 2017 and 31 July 2020 from five European countries, to identify RSV-ARI hospitalizations during infancy. In a nested cohort (n = 993), we performed active RSV surveillance by collecting nasal swabs in case of ARI symptoms during RSV seasons (October–April). Antibiotic use during hospitalization was identified through chart review, while outpatient data were collected via parental questionnaires. Results: In the total cohort, antibiotics were used in 22.8% of RSV hospitalizations (33/145) and 62.5% of RSV intensive care admissions (5/8). In the nested cohort, antibiotics were used in 5.2% of any-severity RSV-ARI (13/250) and 9.9% of medically attended RSV-ARI (13/131). This results in an estimated incidence of 1.3% (95%CI: 0.8–2.0) of healthy term infants receiving ≥1 course of antibiotics associated with RSV infection in their first year, with an incidence rate of 1.1 RSV-associated antibiotic prescriptions per 1000 infant-months (95%CI: 0.6–1.9). As such, RSV accounts for 22.9% of antibiotic prescriptions for ARI during RSV seasons. Conclusions: One in 77 healthy term infants receives antibiotics during RSV infection before their first birthday. Real-world evidence is needed to establish the impact of RSV immunization on antibiotic use during infancy. Clinical Trials Registration: NCT03627572.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Hak, S. F., Venekamp, R. P., Billard, M., Cianci, D., Van Houten, M. A., Pollard, A. J., Heikkinen, T., Cunningham, S., Millar, M., Martinon-Torres, F., Dacosta-Urbieta, A., Bont, L. J., Wildenbeest, J. G., & the PROMISE Investigators. (2025). Antibiotic use attributable to RSV infections during infancy—an international prospective birth cohort study. Journal of Antimicrobial Chemotherapy.

MLA Style

Hak, S. F., et al. “Antibiotic Use Attributable to RSV Infections during Infancy—an International Prospective Birth Cohort Study.” Journal of Antimicrobial Chemotherapy, Oxford University Press, 2025.

Chicago Style

Hak, SF, RP Venekamp, M Billard, D Cianci, MA Van Houten, AJ Pollard, T Heikkinen, et al. 2025. “Antibiotic Use Attributable to RSV Infections during Infancy—an International Prospective Birth Cohort Study.” Journal of Antimicrobial Chemotherapy.
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