High rates of antibiotic prescriptions in children with COVID-19 or multisystem inflammatory syndrome: A multinational experience in 990 cases from Latin America

Acta Paediatr. 2021 Jun;110(6):1902-1910. doi: 10.1111/apa.15847. Epub 2021 Mar 26.


Aim: This study aims to assess rates of antibiotic prescriptions and its determinants in in children with COVID-19 or Multisystem Inflammatory Syndrome (MIS-C).

Methods: Children <18 years-old assessed in five Latin Americas countries with a diagnosis of COVID-19 or MIS-C were enrolled. Antibiotic prescriptions and factors associated with their use were assessed.

Results: A total of 990 children were included: 921 (93%) with COVID-19, 69 (7.0%) with MIS-C. The prevalence of antibiotic use was 24.5% (n = 243). MIS-C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X-rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. There was significant variation in antibiotic use across the hospitals.

Conclusion: Our study showed a high rate of antibiotic prescriptions in children with COVID-19, in particular in those with severe disease or MIS-C. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID-19 children.

Keywords: COVID-19; SARS-COV-2; antibiotics; stewardship.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • COVID-19*
  • Child
  • Female
  • Humans
  • Latin America / epidemiology
  • Prescriptions
  • Prospective Studies
  • SARS-CoV-2
  • Systemic Inflammatory Response Syndrome


  • Anti-Bacterial Agents

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related