Nirsevimab Linked to Lower Antibiotic Use and RSV-Related Illness in Infants, Suggests Study
USA: A new study has found that nirsevimab use during an infant’s first respiratory syncytial virus (RSV) season was associated with lower antibiotic prescribing, with antibiotic use falling by more than 14% for acute respiratory tract infections (ARTIs), by over 40% for bronchiolitis, and by nearly 70% among RSV-related hospitalizations. The findings suggest that preventing RSV illness with nirsevimab may also help reduce unnecessary antibiotic exposure in infants.
The study was published in Clinical Infectious Diseases by Mahaa M Ahmed, Children’s Hospital of Philadelphia, Philadelphia, PA, and colleagues.
Nirsevimab is a monoclonal antibody designed to protect infants against RSV, a major cause of respiratory illness and bronchiolitis in young children. Because respiratory infections can often lead to antibiotic prescriptions even when caused by viruses, the researchers investigated whether preventing RSV with nirsevimab could indirectly reduce antibiotic use.
For the study, researchers used electronic health record data from 32 diverse primary care practices within a healthcare network. They developed a cohort of infants who were younger than 8 months and had visited a primary care practice within their first 14 days of life. The analysis emulated a target trial comparing infants who received nirsevimab with those who did not.
The researchers assessed the time until the first antibiotic prescription associated with three outcomes: outpatient acute respiratory tract infections, outpatient bronchiolitis, and RSV-related hospitalizations. Nirsevimab effectiveness was determined by comparing the risk of antibiotic prescribing between treated and untreated infants.
Key Findings:
- Among 15,341 eligible infants, 7,413 received nirsevimab.
- Nirsevimab was associated with a 14.4% lower risk of antibiotic prescribing for outpatient acute respiratory tract infections (ARTIs).
- Antibiotic prescribing during outpatient bronchiolitis encounters was reduced by 40.3% with nirsevimab.
- Among infants hospitalized with RSV-related illness, nirsevimab was associated with a 69.4% reduction in antibiotic prescribing.
The researchers noted that nirsevimab may offer benefits beyond RSV prevention by reducing antibiotic exposure and supporting antibiotic stewardship.
The study had several limitations. Its Pennsylvania- and New Jersey-based pediatric network may limit generalizability. The retrospective design relied on electronic health record data, and antibiotic prescriptions from outside hospitals or urgent care centers may have been missed. Unmeasured factors, including healthcare utilization, could also have influenced nirsevimab receipt and medically attended infections. In addition, maternal vaccination status was self-reported and not externally verified.
Overall, the findings suggest that nirsevimab can help reduce antibiotic use for respiratory infections in both outpatient and inpatient settings. Improving currently suboptimal nirsevimab coverage could therefore not only reduce RSV-related illness but also complement antibiotic stewardship efforts and help curb antibiotic overuse.
Reference:
Ahmed, M. M., Joerger, T., Wang, Z., Li, Y., & Gerber, J. S. The Effectiveness of Nirsevimab on Antibiotic Use in Children Using Target Trial Emulation. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciag406
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