Unselective use of
antibiotics to treat children with
COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple
antibiotic use in the treatment of children with
COVID-19. The purpose of this study was to assess the prevalence of
antibiotic use, as well as to examine demographic and clinical factors associated with a greater number of
antibiotics and with a longer
antibiotic treatment administered to hospitalized children with
COVID-19 during the lockdown in Serbia. This study included all children who were hospitalized from 6 March to 31 May 2020 at the only pediatric
COVID-19 hospital, and who were confirmed to have
SARS-CoV-2 infection. Demographic, clinical, and laboratory data were collected from medical records. The
antibiotic treatment included the use of
azithromycin,
cephalosporin (
ceftriaxone),
ampicillin-
amikacin, and
hydroxychloroquine. The overall prevalence of
antibiotics use in children hospitalized with
COVID-19 regardless of age was 47.2% (43.3% in children aged 1-5 years and 44.4% in those aged 5-17 years). In children aged 1-5 years, not having a family member affected by
COVID-19 (B = -1.38, 95% confidence interval [CI] -2.43, -0.34, p = 0.011), having
pneumonia on chest X-ray (B = 0.81, 95%CI 0.34, 1.29, p = 0.002), being a boy (B = -0.65, 95%CI -1.17, -0.13, p = 0.018), and having higher
C-reactive protein (CRP) values on admission (B = 0.12, 95%CI 0.07, 0.17, p = 0.001) were associated with the administration of a higher number of
antibiotics. These factors, along with having
fever (B = 3.20, 95%CI 1.03, 5.37, p = 0.006), were associated with a longer duration of
antibiotic treatment in children aged 1-5 years. In children aged 5-17 years, having pharyngeal
erythema (B = 1.37, 95%CI 0.61, 2.13, p = 0.001),
fever (B = 0.43, 95%CI 0.07, 0.79, p = 0.018), and
pneumonia on chest X-ray (B = 0.91, 95%CI 0.53, 1.29, p = 0.001), not having
rhinorrhea (B = -1.27, 95%CI -2.47, -0.08, p = 0.037), being a girl (B = 0.52, 95%CI 0.08, 0.97, p = 0.021), and having higher CRP values on admission (B = 0.04, 95%CI 0.01, 0.06, p = 0.006) were associated with the administration of a higher number of
antibiotics. These factors, not including the absence of
rhinorrhea, were associated with a longer duration of
antibiotics treatment in children aged 5-17 years. Demographic, epidemiological, clinical, and laboratory parameters were associated with the use of multiple
antibiotics and a longer duration of
antibiotic treatment both among children aged 1-5 years and those aged 5-17 years.