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Antibiotic therapy is associated with a longer hospital stay in children under three years diagnosed with RSV-associated lower respiratory infections. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 19, 2026Open Access

Antibiotic Therapy and Factors Predicting Prolonged Hospitalization Among Children Under Three Years Diagnosed With Respiratory Syncytial Virus‐Associated Lower Respiratory Infection

Key Points

The study aims to assess antibiotic use prevalence and identify factors predicting prolonged hospitalization among children with RSV-associated lower respiratory infections.
Conducted a retrospective record review at Abha Maternity and Children's Hospital.
Enrolled 162 children aged 1–36 months diagnosed with RSV-associated LRIs.
Collected demographic, clinical, laboratory, and imaging data relevant to hospitalization.
Analyzed antibiotic therapy and hospital length of stay.
147 out of 162 patients (90.74%) received antibiotic therapy, most commonly azithromycin, cefuroxime, and ceftriaxone.
Average length of stay was significantly longer for those receiving antibiotics (6 days vs. 3 days, p < 0.001).
Factors associated with prolonged hospitalization included antibiotic therapy, pneumonia, and patients under 12 months old.
Younger age and reduced SpO₂ at admission predict longer stays.

Abstract

ABSTRACT Background Respiratory syncytial virus (RSV) is a common cause of lower respiratory infections (LRIs) in infants and young children. Antibiotic overuse remains a significant concern in hospitalized children with RSV‐associated LRIs. This study aimed to investigate the prevalence of antibiotic use and identify predictors of prolonged hospitalization in children with RSV‐LRIs. Methods A retrospective record review study was conducted at Abha Maternity and Children's Hospital, enrolling 162 children aged 1–36 months admitted with RSV‐associated LRIs between January and December 2022. Demographic, clinical, laboratory, and imaging data were collected. Antibiotic therapy and hospital length of stay (LOS) were also retrieved and analyzed. Results Of the 162 patients, 147 (90.74%) received antibiotic therapy, with azithromycin, cefuroxime, and ceftriaxone being the most commonly used. Patients who received antibiotics had a significantly longer median LOS compared to those who did not (6 vs. 3 days, p < 0.001). Factors associated with prolonged LOS (≥ 5 days) included antibiotic therapy use (odds ratio OR = 7.47 (95% confidence intervals CI: 2.18−25.57), pneumonia: OR = 3.58 (95% CI: 1.67−7.67), age < 12 months: OR = 2.80 (95% CI: 1.32−5.89), consolidation: OR = 2.54 (95% CI: 1.16−5.59), age in months: OR = 0.94 (95% CI: 0.91−0.98) (indicates decreasing odds with increasing age), admission respiratory rate: OR = 1.04 (95% CI: 1.01−1.07), and admission peripheral oxygen saturation (SpO 2 ): OR = 0.91 (95% CI: 0.86−0.97) (indicates decreasing odds with higher SpO 2 ). Conclusion The high prevalence of antibiotic use in this study highlights the challenges in differentiating RSV‐LRIs from bacterial pneumonia. Independent predictors of prolonged hospital stay included antibiotic therapy, pneumonia, younger age, lower admission SpO₂, and higher respiratory rate.

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