title: Are antibiotics beneficial to children suffering from enterovirus infection complicated with a high C-reactive protein level?
abstract: BACKGROUND
  Enteroviruses are seasonally prevalent each year in Southeast Asia. Elevated C-reactive protein (CRP) levels have been noted in minor populations of patients, and antibiotics may be prescribed under the impression of a suspected bacterial infection. This prescription might be inappropriate, resulting in further bacterial resistance and medical expense. The aim of this study was to delineate how effective antibiotics are for children suffering from enterovirus infection complicated with a high CRP level.
  
  
  METHODS
  The medical records of children hospitalized between January 2008 and December 2012 with herpangina or hand, foot and mouth disease were reviewed retrospectively. The children enrolled were divided into three groups, A, B, and C, by CRP level, which were <40, 40-80, and ≥ 80 mg/l, respectively. A case-control study of group C divided into subgroups according to the prescription of antibiotics for at least 24h during the admission was conducted for further analysis.
  
  
  RESULTS
  A total 3566 cases were identified; 214 were in group C and 71.0% of them received a prescription for antibiotics. There was a linear trend between a relatively higher CRP level and a higher proportion of antibiotics prescribed in the three groups (p=0.001). In the case-control study, there were no significant differences in age, sex, mean CRP, or febrile days. However, a relatively longer stay of hospitalization was recorded in the subgroup with an antibiotic prescription (p=0.020).
  
  
  CONCLUSIONS
  The present study indicated that antibiotics might not be beneficial in treating these patients, even those with a high CRP level. Clinicians should be more prudent in antibiotic use when no obvious evidence of bacterial infection is found.
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Kuang-Che
authors.initials: KC
authors.lastname: Kuo
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ying-Hsien
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: I-Ling
authors.initials: IL
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yi-Chuan
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chung-Chen
authors.initials: CC
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hsuan-Chang
authors.initials: HC
authors.lastname: Kuo
authors.affiliation: Department of Psychiatry, Kaohsiung Medical University Hospital, Faculty of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Yeh
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd, Niaosong Dist., Kaohsiung City 833, Taiwan. Electronic address: lee900@cgmh.org.tw.
authors.forename: Chen-Hsiang
authors.initials: CH
authors.lastname: Lee
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D002675:Child, Preschool; D060085:Coinfection; D004769:Enterovirus Infections / Q000175:diagnosis / Q000378:metabolism* / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Antibiotics; Enterovirus; Hand; Herpangina; High C-reactive protein; foot and mouth disease