{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:09:41Z","timestamp":1786975781881,"version":"build-2736575974"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Respiratory syncytial virus (RSV) is a leading cause of pediatric viral lower respiratory tract infections (VLRTIs), often leading to inappropriate antibiotic use. Although rapid antigen diagnostic tests (Ag-RDTs) support clinical diagnosis, their effect on antibiotic prescribing in community settings remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association of RSV Ag-RDT implementation with antibiotic prescribing practices for infants and children assessed for LRTIs.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study used data from a community-based primary care setting involving family pediatricians in Italy participating in the Pedianet network. Data were collected between December 2023 and May 2024 from children aged 9 to 36 months with symptoms of VLRTI who underwent RSV Ag-RDT during the 2023-2024 respiratory epidemiologic season and historical matched cohorts.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Children with RSV-positive and RSV-negative Ag-RDT results were compared with each other and with matched historical (2022-2023) and contemporaneous (2023-2024) cohorts of children with clinically diagnosed VLRTIs or bronchiolitis who did not undergo laboratory testing.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was antibiotic prescribing within 14 days of diagnosis. Prescriptions associated with suspected or confirmed bacterial infections (such as elevated C-reactive protein levels or documented coinfections) were excluded. Relative risks (RRs) and 95% CIs were estimated using log-binomial regression models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 256 cases (median age, 15.06 [IQR, 11.61-22.72] months; 133 males [51.95%]), 79 (30.86%) were RSV positive and 177 (69.14%) were RSV negative. These 2 groups were comparable in age, with RSV-negative children slightly younger (median age, 14.95 [IQR, 11.66-22.67] vs 15.34 [IQR, 11.40-23.10] months), and in sex distribution, with a higher proportion of females among RSV-positive cases (41 [51.90%] vs 82 [46.33%]). Antibiotic prescribing was lower in RSV-positive than RSV-negative children (0.18 [95% CI, 0.10-0.25] vs 0.29 [95% CI, 0.22-0.35] prescriptions per 10 person-days) and was associated with a reduction in risk of receiving an antibiotic prescription (RR, 0.52; 95% CI, 0.33-0.83). Implementation of RSV Ag-RDT was associated with lower antibiotic use for VLRTIs compared with a matched untested cohort (RR, 0.54 [95% CI, 0.44-0.66] in 2022-2023 and 0.61 [95% CI, 0.50-0.75] in 2023-2024) and for bronchiolitis in 2022-2023 (RR, 0.56 [95% CI, 0.33-0.95]) but not in 2023-2024 (RR, 0.75 [95% CI, 0.42-1.33]). Reductions were greater among RSV-positive cases: for VLRTIs, the RR was 0.33 (95% CI, 0.20-0.52) in 2022-2023 and 0.41 (95% CI, 0.25-0.67) in 2023-2024; for bronchiolitis, the RR was 0.33 (95% CI, 0.15-0.76) in 2022-2023, but the reduction was not significant in 2023-2024 (RR, 0.43 [95% CI, 0.18-1.00]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort of 256 VLRTI cases, the findings suggest that RSV contributed to a broad range of VLRTIs across ages and that RSV Ag-RDT was a useful outpatient antimicrobial stewardship tool, particularly in bronchiolitis. Combined with universal immunoprophylaxis, widespread Ag-RDT use may improve diagnostic accuracy, resource allocation, and clinical outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.0409","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T16:00:21Z","timestamp":1772553621000},"page":"e260409","source":"Crossref","is-referenced-by-count":2,"title":["RSV Detection and Antibiotic Prescribing Decisions for Pediatric Respiratory Tract Infections"],"prefix":"10.1001","volume":"9","author":[{"given":"Riccardo","family":"Boracchini","sequence":"first","affiliation":[{"name":"Laboratory of Healthcare Research and Pharmacoepidemiology, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy"},{"name":"Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Brigadoi","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Salvadori","sequence":"additional","affiliation":[{"name":"Laboratory of Healthcare Research and Pharmacoepidemiology, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Padoan","sequence":"additional","affiliation":[{"name":"Department of Medicine\u2013DIMED, University of Padua, Padova, Italy"},{"name":"Department of Laboratory Medicine, University Hospital of Padua, Padova, 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