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Background Respiratory Syncytial Virus (RSV) is a major cause of seasonal morbidity and mortality among adults in Italy with an estimated 291,000 cases and more than 26,000 annual hospitalizations in adults. Although the viral cause of infection, evidence showed a consistent antibiotic (ATB) prescription rate. This is largely due to diagnostic uncertainty, the high risk of bacterial coinfection, and the severity of RSV presentations. Recent Italian cohort data show that over 60% of RSV-hospitalized older adults are prescribed ATBs during their hospitalization, even though confirmed bacterial coinfection rates are much lower. Vaccination reduces RSV-associated hospitalizations and severe respiratory illness, WHO framed RSV vaccination as a very promising tool also to reduce ATB prescription and to contain antimicrobial resistance (AMR). Objectives of this work were to collect evidence on the prescription of ATB for RSV adult patients in Italy and their reduction after vaccination.Materials and Methods We conduct a literature review about RSV clinical management in Italy including antibiotic exposure and RSV vaccination impact on ATB consumption. Where ATB event counts were available, study-level proportions were calculated. A DerSimonian–Laird random-effects meta-analysis of proportions was performed for independent primary care outpatient cohorts. An administrative database study on 12-month antibiotic exposure (ATC J01) was analyzed separately.Results Four peer-reviewed studies were selected plus a study analyzing the ATB prescriptions in a one year follow up of RSV-confirmed patients ( table 1). Among primary care outpatients the pooled rate of ATB prescription was 55.7% (95% CI 46.2–65.1%), τ2 = 0, compared with 77.0–78.7% in hospitalized RSV patients. In the administrative database study, during a 1 year follow-up 181/289 (62.6%) RSV-patients received systemic ATB. More prescribed were fluoroquinolones (33.2%), amoxicillin/beta-lactamase inhibitor (24.6%), macrolides (24.6%). The use of a static multi-cohort Markov model was the unique available report estimating the number of RSV cases and associated health outcomes projected in Italy in adults ≥75 y and high-risk adults ≥60 y with no RSV vaccination vs a single dose of adjuvanted RSVPreF3 OA vaccine in a three-year timeframe. Assuming vaccination rate of 75%, vaccine could decrease RSV related lower respiratory tract infections cases by 43%, among these patients.Discussion The use of ATB in the clinical management of RSV disease in adults in Italy turned out to be consistent, most prescriptions are in the WHO Watch or Reserve classes. Real-world effectiveness studies and physician surveys in Italy indicate that improved RSV prevention through vaccination will impactful reduce unnecessary ATB use, by decreasing RSV-related hospitalizations and clarifying the etiology of respiratory illness. This strategy will also improve general health, lower direct healthcare costs and tackling AMR.Abstract OC77 Table 1Antibiotic prescribing in RSV-positive adults across Italian clinical settings