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Hagedoorn NN, Borensztajn DM, Nijman R, Balode A, von Both U, Carrol ED, Eleftheriou I, Emonts M, van der Flier M, de Groot R, Herberg J, Kohlmaier B, Lim E, Maconochie I, Martinon-Torres F, Nieboer D, Pokorn M, Strle F, Tsolia M, Yeung S, Zavadska D, Zenz W, Vermont C, Levin M, Moll HA. Variation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE): A multicentre observational study. PLoS Med 2020; 17:e1003208. [PMID: 32813708 PMCID: PMC7444592 DOI: 10.1371/journal.pmed.1003208] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/28/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe. METHODS AND FINDINGS Between January 2017 and April 2018, data were prospectively collected on febrile children aged 0-18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), disease severity (e.g., triage level, fever duration, presence of alarming signs), use and result of diagnostics, and focus and cause of infection. In this analysis of 35,650 children (median age 2.8 years, 55% male), overall antibiotic prescription rate was 31.9% (range across EDs: 22.4%-41.6%), and among those prescriptions, the broad-spectrum antibiotic prescription rate was 52.1% (range across EDs: 33.0%-90.3%). After standardisation, differences in antibiotic prescriptions ranged from 0.8 to 1.4, and the ratio between broad-spectrum and narrow-spectrum prescriptions ranged from 0.7 to 1.8 across EDs. Standardised antibiotic prescription rates varied for presumed bacterial infections (0.9 to 1.1), presumed viral infections (0.1 to 3.3), and infections of unknown cause (0.1 to 1.8). In all febrile children, antibiotic prescriptions were appropriate in 65.0% of prescriptions, inappropriate in 12.5% (range across EDs: 0.6%-29.3%), and inconclusive in 22.5% (range across EDs: 0.4%-60.8%). Prescriptions were of inappropriate duration in 20% of oral prescriptions (range across EDs: 4.4%-59.0%). Oral prescriptions were not concordant with the local guideline in 22.3% (range across EDs: 11.8%-47.3%) of prescriptions in uncomplicated RTIs and in 45.1% (range across EDs: 11.1%-100%) of prescriptions in uncomplicated urinary tract infections. A limitation of our study is that the included EDs are not representative of all febrile children attending EDs in that country. CONCLUSIONS In this study, we observed wide variation between European EDs in prescriptions of antibiotics and broad-spectrum antibiotics in febrile children. Overall, one-third of prescriptions were inappropriate or inconclusive, with marked variation between EDs. Until better diagnostics are available to accurately differentiate between bacterial and viral aetiologies, implementation of antimicrobial stewardship guidelines across Europe is necessary to limit antimicrobial resistance.
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Affiliation(s)
- Nienke N. Hagedoorn
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Dorine M. Borensztajn
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Ruud Nijman
- Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Anda Balode
- Department of Paediatrics, Children’s Clinical University Hospital, Rīgas Stradiņa Universitāte, Riga, Latvia
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, Ludwig Maximilian University, Munich, Germany
- Partner Site Munich, German Center for Infection Research (DZIF), Munich, Germany
| | - Enitan D. Carrol
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Irini Eleftheriou
- Second Department of Paediatrics, P. & A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michiel van der Flier
- Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald de Groot
- Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marko Pokorn
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maria Tsolia
- Second Department of Paediatrics, P. & A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Shunmay Yeung
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Dace Zavadska
- Department of Paediatrics, Children’s Clinical University Hospital, Rīgas Stradiņa Universitāte, Riga, Latvia
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Clementien Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Michael Levin
- Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Henriëtte A. Moll
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, the Netherlands
- * E-mail:
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102
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Sohn M, Chung D, Winterholler E, Hammershaimb B, Leist C, Kucera M, Trombly M, Tracey J, Dregansky G, Schauer M, Rauch H, Woodwyk A, VanLoo D, Warner A, Klepser ME. Assessment of antibiotic use and concordance with practice guidelines within 3 diverse ambulatory clinic systems. J Am Pharm Assoc (2003) 2020; 60:930-936.e10. [PMID: 32713749 DOI: 10.1016/j.japh.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objectives of this study were (1) to determine the rate of antibiotic prescribing at ambulatory clinics, and (2) to assess the concordance of antibiotic prescriptions with published guidelines and Food and Drug Administration-approved indications in terms of drug choices and dosing regimen. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Patients of all ages receiving at least 1 prescription during ambulatory visits in 2016 to 2017 were observed. OUTCOME MEASURES For each of the 3 clinic systems included in this study, oral antibiotic prescribing rates were estimated per patient and per ambulatory visit. Then, the concordance of oral antibiotic prescribing was assessed with respect to (1) choice of agent and (2) the dosing regimen by comparing it to the recommended therapeutic regimen (RTR). RESULTS A total of 284,348 patients receiving at least 1 prescription were included in the analysis. Between clinics, 17.4 to 43.7 per 100 patients received antibiotics. Of the antibiotics prescribed, 48.9% in Clinic A, 48.0% in Clinic B, and 60.7% in Clinic C were considered to be discordant in terms of drug choice. When the dosing regimen was taken into account in addition to the choice of agent, 72.6% in Clinic A, 76.7% in Clinic B, and 81.6% in Clinic C were discordant based on drug choice or dosing regimen. Of the prescriptions written with a discordant dosing regimen, 91.2% in Clinic A, 79.6% in Clinic B, and 91.0% in Clinic C were at a higher dosage than RTR. CONCLUSION Antibiotic prescribing rates vary by clinics, whereas discordant prescribing is consistently prevalent across clinics. More efforts should be put into ambulatory care to address antibiotic misuse problems, and our method could improve ambulatory antimicrobial stewardship programs.
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103
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Klatte JM. Pediatric Antimicrobial Stewardship Programs: Current Perspectives. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:245-255. [PMID: 32801990 PMCID: PMC7383043 DOI: 10.2147/phmt.s224774] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022]
Abstract
With the rapid growth of the field of pediatric antimicrobial stewardship, there has been a marked increase in the establishment of programs dedicated to this specialty. Shared objectives of all pediatric antimicrobial stewardship programs (ASPs) include optimization of antibiotic use and improvement in clinical outcomes for children, while certain core operational strategies and metrics used to measure program effectiveness are typically utilized by pediatric ASPs. Antimicrobial stewardship is the responsibility of every individual who prescribes, dispenses, and administers antibiotics to children, and pediatric ASP principles are rooted in collaboration and cooperation. Pediatric ASPs are uniquely suited to meet the needs of the local populations they serve and the environments within which they practice while also fostering an awareness of the interconnected global nature of pediatric stewardship. As such, pediatric ASPs are well positioned to confront the evolving challenges of antimicrobial overuse and resistance.
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Affiliation(s)
- J Michael Klatte
- Division of Infectious Disease, Dayton Children's Hospital, Dayton, OH, USA
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104
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Improving Antibiotic Prescribing for Children With Urinary Tract Infection in Emergency and Urgent Care Settings. Pediatr Emerg Care 2020; 36:e332-e339. [PMID: 29298246 DOI: 10.1097/pec.0000000000001342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with urinary tract infection (UTI) are often diagnosed in emergency and urgent care settings and increasingly are unnecessarily treated with broad-spectrum antibiotics. This study evaluated the effect of a quality improvement intervention on empiric antibiotic prescribing for the treatment of uncomplicated UTI in children. METHODS A local clinical pathway for uncomplicated UTI, introduced in June 2010, recommended empiric treatment with cephalexin, a narrow-spectrum (first-generation) cephalosporin antibiotic. A retrospective quasi-experimental study of pediatric patients older than 1 month presenting to emergency and urgent care settings from January 1, 2009, to December 31, 2014, with uncomplicated UTI was conducted. Hospitalized patients and those with chronic conditions or urogenital abnormalities were excluded. Control charts and interrupted time-series analysis were used to analyze the primary outcome of narrow-spectrum antibiotic prescribing rates and the balancing measures of 72-hour revisits, resistant bacterial isolates, and subsequent inpatient admissions for UTI. RESULTS A total of 2134 patients were included. There was an immediate and sustained significant increase in cephalexin prescribing before (19.2%) versus after (79.6%) pathway implementation and a concurrent significant decline in oral third-generation cephalosporin (cefixime) prescribing from 50.3% to 4.0%. There was no significant increase in 72-hour revisits, resistant bacterial isolates, or inpatient admissions for UTI. CONCLUSIONS A clinical pathway produced a significant and sustained increase in narrow-spectrum empiric antibiotic prescribing for pediatric UTI. Increased empiric cephalexin prescribing did not result in increased treatment failures or adverse patient outcomes. Future studies on implementing clinical pathways for children outside a pediatric hospital network are needed.
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105
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Kianmehr H, Sabounchi NS, Sabounchi SS, Cosler LE. A system dynamics model of infection risk, expectations, and perceptions on antibiotic prescribing in the United States. J Eval Clin Pract 2020; 26:1054-1064. [PMID: 31206901 DOI: 10.1111/jep.13203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Inappropriate antibiotic prescribing is still a major concern that can lead to devastating outcomes including antibiotic resistance. This study aimed to simulate the antibiotic prescribing behaviour by providers for acute respiratory tract infections (ARTIs) and to evaluate the impact of patient expectation, provider's perception of patient's expectation to receive a prescription, and patient's risk for bacterial infection, on the decision to prescribe. METHODS We developed a unique system dynamics (SD) simulation model based on the significant factors that impact the interaction between provider and patient during visits for ARTIs and the decision to prescribe antibiotics. In order to validate the model for different age groups and regions in the United States, we used the sample of 53 000 ARTI patient visits made at outpatient settings between 1993 and 2015, based on the National Ambulatory Medical Care Survey (NAMCS). RESULTS Simulation results reveal that physician diagnosis for prescribing antibiotics is based on physician's experience from their prior prescribing behaviour, their perception of patient's infection risk, and patient's expectation to receive antibiotics. Also, there are some variations depending on patient's age and residential region. The simulation analysis also depicts the decreasing trend in patient's expectation over the past two decades for most age groups and regions. CONCLUSIONS Given the high number of unnecessary prescriptions for ARTI, we found that policies are needed to influence provider's prescribing behaviour through patient's expectation and provider's perception regarding those expectations. Our simulation framework can further be used by policymakers to design and evaluate interventions that may modify the interaction between health providers and patients to optimize antibiotic prescriptions among ARTI patients for different regions and age groups.
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Affiliation(s)
- Hamed Kianmehr
- Thomas J. Watson School of Engineering and Applied Science, Binghamton University, Binghamton, New York
| | - Nasim S Sabounchi
- Thomas J. Watson School of Engineering and Applied Science, Binghamton University, Binghamton, New York
| | | | - Leon E Cosler
- Founding Chair, Department of Health Outcomes and Administrative Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, New York
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106
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Zhuo C, Wei X, Zhang Z, Hicks JP, Zheng J, Chen Z, Haldane V, Walley J, Guan Y, Xu H, Zhong N. An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial. Trials 2020; 21:394. [PMID: 32398065 PMCID: PMC7216131 DOI: 10.1186/s13063-020-04303-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inappropriate prescribing of antibiotics for acute respiratory infections at the primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China's primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages. METHODS We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers. The family physician components include: (1) training using new operational guidelines, (2) improved management and peer-review of antibiotic prescribing, (3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key non-antibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months' post-trial long-term follow-up. DISCUSSION Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low- or middle-income country (LMIC). All interventional activities will be designed to be embedded into routine primary care with strong local ownership. Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription for primary care facilities in rural China and other LMICs. TRIAL REGISTRATION ISRCTN, ID: ISRCTN96892547. Registered on 18 August 2019.
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Affiliation(s)
- Chao Zhuo
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Jinkun Zheng
- Yuebei People’s Hospital, Shaoguan, Guangdong China
| | - Zhixu Chen
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
| | - Victoria Haldane
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Yubao Guan
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
| | - Hongyan Xu
- Yuebei People’s Hospital, Shaoguan, Guangdong China
| | - Nanshan Zhong
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Laboratory of Guangdong-Hong Kong -Macao Great Bay, Guangzhou Medical University, 151 Yanjiang Xi Rd, Guangzhou City, 510120 Guangdong China
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107
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Wang CN, Huttner BD, Magrini N, Cheng Y, Tong J, Li S, Wan C, Zhu Q, Zhao S, Zhuo Z, Lin D, Yi B, Shan Q, Long M, Jia C, Zhao D, Sun X, Liu J, Zhou Y, Li R, Liu J, Zhu Y, Miao R, Zhu C, Qi Z, Wang C, Wu S, Xu X, Zhou L, Ye W, Luo N, Gao H, Yang P, Bieerding M, Tang J, Zeng M. Pediatric Antibiotic Prescribing in China According to the 2019 World Health Organization Access, Watch, and Reserve (AWaRe) Antibiotic Categories. J Pediatr 2020; 220:125-131.e5. [PMID: 32093934 DOI: 10.1016/j.jpeds.2020.01.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess clinical indication-specific antibiotic prescribing in pediatric practice in China based on the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) metrics and to detect potential problem areas. STUDY DESIGN Pediatric prescription records on the 16th of each month during 2018 were sampled for all encounters at outpatient and emergency departments of 16 tertiary care hospitals via hospital information systems. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) classification. RESULTS A total of 260 001 pediatric encounters were assessed, and antibiotics were prescribed in 94 453 (36.3%). In 35 167 encounters (37.2%), at least 1 intravenous antibiotic was administered. WHO Watch group antibiotics accounted for 82.2% (n = 84 176) of all antibiotic therapies. Azithromycin (n = 15 791; 15.4%) was the most commonly prescribed antibiotic, and third-generation cephalosporins (n = 44 387; 43.3%) were the most commonly prescribed antibiotic class. In at least 66 098 encounters (70.0%), antibiotics were prescribed for respiratory tract conditions, mainly for bronchitis/bronchiolitis (n = 25 815; 27.3%), upper respiratory tract infection (n = 25 184; 26.7%), and pneumonia (n = 13 392; 14.2%). CONCLUSIONS Overuse and misuse of WHO Watch group antibiotics for respiratory tract conditions and viral infectious diseases is common in pediatric outpatients in China. Pediatric antimicrobial stewardship should be strengthened using WHO AWaRe metrics.
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Affiliation(s)
- Chu-Ning Wang
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Benedikt D Huttner
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicola Magrini
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Yibing Cheng
- Emergency Department, Henan Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jianning Tong
- Department of Pediatric Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Shuangjie Li
- Department of Hepatology, Hunan Children's Hospital, Changsha, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
| | - Qingxiong Zhu
- Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Shiyong Zhao
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou, China
| | - Zhiqiang Zhuo
- Department of Infectious Diseases, Xiamen Children's Hospital, Xiamen, China
| | - Daojiong Lin
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Hainan, China
| | - Bin Yi
- Department of Neonatology, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Qingwen Shan
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mei Long
- Department of Pediatric Gastroenterology, Guiyang Maternal and Child Hospital, Guiyang, China
| | - Chunmei Jia
- Department of Pediatrics, The Fourth Hospital of Baotou, Baotou, China
| | - Dongchi Zhao
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Sun
- Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Wulumuqi, China
| | - Juan Liu
- Department of Pediatrics, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Yibo Zhou
- Department of General Pediatrics, Henan Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Rui Li
- Department of Pediatric Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Jing Liu
- Department of Infectious Diseases, Hunan Children's Hospital, Changsha, China
| | - Yu Zhu
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
| | - Ruixue Miao
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
| | - Chunhui Zhu
- Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Zhenghong Qi
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou, China
| | - Caihong Wang
- Department of Infectious Diseases, Xiamen Children's Hospital, Xiamen, China
| | - Shouye Wu
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Hainan, China
| | - Xiaohong Xu
- Department of Digestive Infection, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Li Zhou
- Department of Digestive Infection, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Wenyu Ye
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Na Luo
- Department of Pediatric Gastroenterology, Guiyang Maternal and Child Hospital, Guiyang, China
| | - Huiling Gao
- Department of Pharmacy, The Fourth Hospital of Baotou, Baotou, China
| | - Pu Yang
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Maihebuba Bieerding
- Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Wulumuqi, China
| | - Jie Tang
- Department of Pharmacy, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.
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108
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Frost HM, Becker LF, Knepper BC, Shihadeh KC, Jenkins TC. Antibiotic Prescribing Patterns for Acute Otitis Media for Children 2 Years and Older. J Pediatr 2020; 220:109-115.e1. [PMID: 32111379 PMCID: PMC7249267 DOI: 10.1016/j.jpeds.2020.01.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the frequency that non-first-line antibiotics, safety-net antibiotic prescriptions (SNAPS), and longer than recommended durations of antibiotics were prescribed for children ≥2 years of age with acute otitis media and examine patient and system level factors that contributed to these outcomes. STUDY DESIGN Children age ≥2 years with acute otitis media seen at Denver Health Medical Center outpatient locations from January to December 2018 were included. The percentages of patients who received first-line antibiotics, SNAPs, and recommended durations of antibiotics were determined. Factors associated with non-first-line and longer than recommended antibiotic durations were evaluated using multivariate logistic regression modeling. RESULTS Of the 1025 visits evaluated, 98.0% were prescribed an antibiotic; only 4.5% of antibiotics were SNAPs. Non-first-line antibiotics were prescribed to 18.8% of patients. Most antibiotic durations (94.1%) were longer than the institution recommended 5 days and 54.3% were ≥10 days. Private insurance was associated with non-first-line antibiotics (aOR, 1.89; 95% CI, 1; 14-3.14, P = .01). Patients who were younger (2-5 years; aOR 2.01; 95% CI, 1.32-3.05; P < .001) or seen in emergency/urgent care sites (aOR, 1.73; 95% CI, 1.26-2.38; P < .001) were more likely to receive ≥10 days of antibiotic compared with those in pediatric clinics. CONCLUSIONS Antibiotic stewardship interventions that emphasize the duration of antibiotic therapy as well as the use of SNAPs or observation may be higher yield than those focusing on first-line therapy alone. Numerous system and patient level factors are associated with off-guideline prescribing.
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Affiliation(s)
- Holly M Frost
- Department of Pediatrics, Denver Health Medical Center, Denver, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Lauren F Becker
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Bryan C Knepper
- Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO
| | | | - Timothy C Jenkins
- Division of Infectious Diseases and Department of Medicine, Denver Health Medical Center, Denver, CO; Department of Internal Medicine-Infectious Diseases, University of Colorado School of Medicine, Aurora, CO
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Mudd SS, Alvarado SM, Otaru S, Canares T. Urgent Care Utilization in a Pediatric Population With Private Health Insurance. J Pediatr Health Care 2020; 34:e21-e27. [PMID: 32089395 DOI: 10.1016/j.pedhc.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pediatric urgent care (UC) utilization patterns have been studied in Medicaid enrollees, but not in those with private insurance. METHODS Utilization patterns of UC at a suburban pediatric primary care practice with patients with private health insurance were reviewed. Descriptive data were obtained. RESULTS Three hundred twenty-five charts were reviewed. Most UC visits were for children under 6 years of age (59.7%), a diagnosis of fever (12.2%), and with low severity illness (57.8%). Seventy percent occurred during weekdays and during times when the primary care practice was open. Most children (67.4%) had a diagnostic test performed at UC and 42.2% received a prescription for antibiotics. DISCUSSION Primary care providers should target caregiver education on low acuity conditions and consider process improvements to accommodate urgent visits. While pediatric UC benchmarks are needed, data suggests that general UCs are at risk for overprescribing antibiotics compared to national ambulatory averages.
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110
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Tham DWJ, Abubakar U, Tangiisuran B. Prevalence and predictors of antibiotic use among children visiting the Emergency Department in a Tertiary Hospital in Malaysia. Eur J Pediatr 2020; 179:743-748. [PMID: 31900590 DOI: 10.1007/s00431-019-03560-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/30/2019] [Accepted: 12/23/2019] [Indexed: 12/31/2022]
Abstract
Inappropriate use of antibiotics in human and animal is one of the causes of antimicrobial resistance. This study evaluates the prevalence and predictors of antibiotic use among pediatric patients visiting the Emergency Department (ED) in Malaysia. A retrospective cross-sectional study was conducted in the ED of a tertiary hospital. Data of children aged 2 to 11 years who visited the ED from January-May 2015 were extracted from the patient's assessment forms. A total of 549 children were included in the analysis (median age 5 years) of which 54.3% were boys. Upper respiratory tract infections (URTI) were the most common diagnosis. Antibiotic was prescribed in 43.5% of the children. Children who visited the ED during the weekend (OR, 1.65; 95% confidence interval (CI) 1.13-2.40, P = 0.009), those diagnosed with URTI (OR 3.81; 95% CI, 2.45-5.93, P < 0.001) and those with a longer duration of fever (OR, 1.31; 95% CI, 1.15-1.48, P < 0.001) were more likely to have an antibiotic prescription.Conclusions: Antibiotic was prescribed in more than one-third of children who visited the ED and antibiotic use was associated with visits during the weekend, URTI, and duration of fever. Antimicrobial stewardship program is recommended in the pediatric ED to improve appropriate use of antibiotics.What is Known:•Use of antibiotic among children increases the risk of antibiotic resistance and adverse drug reactions.•Patient-, clinical-, and prescriber-related factors are three important domain associated with antibiotic use in children.What is New:•Fever and upper respiratory tract infections account for majority of antibiotic prescriptions.•The "weekend effect" influences the use of antibiotics in the ED while upper respiratory tract infection is the strongest predictor of antibiotic use among children visiting the ED.
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Affiliation(s)
- Daniel Wai Je Tham
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, George Town, Penang, Malaysia
| | - Usman Abubakar
- National Poison Centre, Universiti Sains Malaysia, 11800, George Town, Penang, Malaysia
| | - Balamurugan Tangiisuran
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, George Town, Penang, Malaysia. .,National Poison Centre, Universiti Sains Malaysia, 11800, George Town, Penang, Malaysia.
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111
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Antibiotic Prescribing for Viral Respiratory Infections in the Pediatric Emergency Department and Urgent Care. Pediatr Infect Dis J 2020; 39:406-410. [PMID: 32176186 DOI: 10.1097/inf.0000000000002586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Viral acute respiratory tract infections (vARTI) are a frequent source of inappropriate antibiotic prescribing. We describe the prevalence of antibiotic prescribing for vARTI in the pediatric emergency department (ED) and urgent care (UC) within a health system, and identify factors associated with overall and broad-spectrum antibiotic prescribing. METHODS Retrospective chart review within a single pediatric referral health system. Visits of patients, 3 months- 17 years old, with a discharge diagnosis of a vARTI from 2010 to 2015. Data collected included specific vARTI diagnosis, site type (ED or UC), provider type [pediatric emergency medicine subspecialist or physicians, nurse practitioners, physician assistants (non-PEM)] and discharge antibiotics. Odds ratios and 95% confidence intervals (CI) were calculated where appropriate. RESULTS There were 132,458 eligible visits, mean age 4.1 ± 4.3 years. Fifty-three percent were treated in an ED. Advanced practice providers, a term encompassing nurse practitioners and physician assistants, were the most common provider type (47.7%); 16.5% of patients were treated by a pediatric emergency medicine subspecialist. Antibiotics were prescribed for 3.8% (95% CI: 3.72-3.92) of children with vARTI; 25.4% (95% CI: 24.2-26.6) of these were broad-spectrum, most commonly first-generation cephalosporins (11%; 95% CI 10.2-11.9). Patients treated in an ED or by a non-PEM and those receiving chest radiograph (CXR) received antibiotics most frequently. Prescribing rates varied by specific vARTI diagnosis. CONCLUSIONS Patients discharged from the pediatric ED or UC with vARTI receive inappropriate antibiotics at a lower rate than reported in other community settings; however, they frequently receive broad-spectrum agents.
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112
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March-López P, Madridejos R, Tomas R, Boix L, Arcenillas P, Gómez L, Padilla E, Xercavins M, Martinez L, Riera M, Badia C, Nicolás J, Calbo E. Impact of a Multifaceted Antimicrobial Stewardship Intervention in a Primary Health Care Area: A Quasi-Experimental Study. Front Pharmacol 2020; 11:398. [PMID: 32300302 PMCID: PMC7142248 DOI: 10.3389/fphar.2020.00398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
The aim of the study was to evaluate the impact of a multifaceted antimicrobial stewardship intervention on antibiotic consumption in a primary health care (PHC) area in Spain. Quasi-experimental study conducted in a PHC area with nine PHC centers, a 400-bed acute care teaching hospital, and 18 nursing homes serving a population of 260,561. The intervention was based on the 2016 CDC Core Elements of Outpatient Antibiotic Stewardship publication and targeted 130 PHC physicians, 41 PHC pediatricians, 19 emergency physicians, and 18 nursing home physicians. The components were commitment, actions for improving antibiotic prescribing, tracking and feedback, and education and experience. The primary outcome was overall antibiotic consumption. Secondary outcomes were consumption of antibiotics to treat pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, and urinary tract infection (UTI), percentage of patients treated with specific antibiotics, and dispensing costs. Consumption was measured in defined daily doses per 1,000 inhabitants per day (DID) and compared pre- and postintervention (2016 vs. 2018). Overall antibiotic consumption decreased from 16.01 to 13.31 DID (−16.85%). Consumption of amoxicillin/clavulanic acid and quinolones decreased from 6.04 to 4.72 DID (−21.88%) and 1.64 to 1.23 DID (−25.06%), respectively. The percentage of patients treated with antibiotics decreased from 26.99 to 22.41%. The intervention resulted in cost savings of €72,673. Use of antibiotics to treat pharyngotonsillitis, UTI, and acute otitis media, sinusitis, and bronchitis decreased significantly. Our antimicrobial stewardship program led to a decrease in antibiotic consumption and significantly improved the use of antibiotics for the most prevalent PHC infections.
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Affiliation(s)
- Pablo March-López
- Hospital Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Primary Care Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Rosa Madridejos
- Primary Care Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Rosa Tomas
- Primary Care Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Lucía Boix
- Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain.,Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Paula Arcenillas
- Hospital Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Lucía Gómez
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Emma Padilla
- Microbiology Department, Centre d'analítiques Terrassa (Catlab), Barcelona, Spain
| | - Mariona Xercavins
- Microbiology Department, Centre d'analítiques Terrassa (Catlab), Barcelona, Spain
| | - Laura Martinez
- Hospital Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Montserrat Riera
- Infection Control Nurse, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Cristina Badia
- Infection Control Nurse, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Jordi Nicolás
- Hospital Pharmacy, Pharmacy Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Clinical Pharmacy Department, Universitat de Barcelona, Barcelona, Spain
| | - Esther Calbo
- Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain.,Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Barcelona, Spain
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113
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Rational use of antimicrobials in the treatment of upper airway infections. J Pediatr (Rio J) 2020; 96 Suppl 1:111-119. [PMID: 31857096 PMCID: PMC9432007 DOI: 10.1016/j.jped.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self-limited, and typically viral condition: upper airway respiratory infections. SOURCES Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients. SUMMARY OF THE FINDINGS Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones. CONCLUSIONS Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials.
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114
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Alfayate Miguélez S, Garcia‐Marcos L. Rational use of antimicrobials in the treatment of upper airway infections. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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115
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Obande GA, Banga Singh KK. Current and Future Perspectives on Isothermal Nucleic Acid Amplification Technologies for Diagnosing Infections. Infect Drug Resist 2020; 13:455-483. [PMID: 32104017 PMCID: PMC7024801 DOI: 10.2147/idr.s217571] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 11/16/2019] [Indexed: 12/13/2022] Open
Abstract
Nucleic acid amplification technology (NAAT) has assumed a critical position in disease diagnosis in recent times and contributed significantly to healthcare. Application of these methods has resulted in a more sensitive, accurate and rapid diagnosis of infectious diseases than older traditional methods like culture-based identification. NAAT such as the polymerase chain reaction (PCR) is widely applied but seldom available to resource-limited settings. Isothermal amplification (IA) methods provide a rapid, sensitive, specific, simpler and less expensive procedure for detecting nucleic acid from samples. However, not all of these IA techniques find regular applications in infectious diseases diagnosis. Disease diagnosis and treatment could be improved, and the rapidly increasing problem of antimicrobial resistance reduced, with improvement, adaptation, and application of isothermal amplification methods in clinical settings, especially in developing countries. This review centres on some isothermal techniques that have found documented applications in infectious diseases diagnosis, highlighting their principles, development, strengths, setbacks and imminent potentials for use at points of care.
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Affiliation(s)
- Godwin Attah Obande
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Microbiology, Faculty of Science, Federal University Lafia, Lafia, Nasarawa State, Nigeria
| | - Kirnpal Kaur Banga Singh
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
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116
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Camcioglu Y, Sener Okur D, Aksaray N, Darendeliler F, Hasanoglu E. Factors affecting physicians' perception of the overuse of antibiotics. Med Mal Infect 2020; 50:652-657. [PMID: 32046887 DOI: 10.1016/j.medmal.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/20/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We aimed to determine the reasons for irrational antibiotic use, to evaluate knowledge, attitudes, and behaviors of physicians regarding such use, to find factors affecting knowledge of physicians, and to explore precautions that need to be taken to stop irrational antibiotic use. MATERIAL AND METHODS We performed the study between January 2014 and June 2014. We included 202 physicians who answered a questionnaire with 22 multiple-choice questions about knowledge (eight questions), behavior and attitudes of physicians (nine questions), and recommendations for reducing antibiotic consumption (five questions). Answers to all questions were assessed according to the physician's age, educational status, metropolitan areas, and healthcare facilities. RESULTS The effects of parents' expectations and satisfaction (7.4%-40.0%) (P<0.0001) and socioeconomical status of families (33%-62%) (P=0.007) increased as the participants' age decreased. Participants working at public hospitals (42.6%) considered expectations and satisfaction of parents more important than other participants (10.5%-26.9%; P=0.002). Rapid recovery of patients was not an essential determinant for administering antibiotics for pediatricians (25.7%) and pediatric assistants (26.9%). However, it was important for emergency physicians (55.6%) and family physicians (60%, P=0.016). Physicians working at university hospitals did not consider this determinant as important as physicians working in other healthcare facilities (P=0.001). CONCLUSION To determine the obstacles associated with promoting rational antibiotic usage, every country should assess the attitudes, behavior, and knowledge of physicians related to such use. The present study is one of the few in Turkey to address the problems associated with irrational antibiotic use.
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Affiliation(s)
- Y Camcioglu
- Istanbul University Cerrahpasa Faculty of Medicine Department of Pediatrics Division of Pediatric Infectious Diseases, Clinical Immunology and Allergy, Istanbul, Turkey
| | - D Sener Okur
- Istanbul University Cerrahpasa Faculty of Medicine Department of Pediatrics, Division of Pediatric Infectious Diseases, 1200 Evler mah 2026 sk Can Evler Sitesi C Blok Kat:4 Daire:10, 20050 Denizli, Turkey.
| | - N Aksaray
- Cukurova University Faculty of Medicine Department of Pediatrics, Division of Pediatric Infectious Diseases, Adana, Turkey
| | - F Darendeliler
- Istanbul University Faculty of Medicine Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey
| | - E Hasanoglu
- Gazi University Faculty of Medicine Department of Pediatrics, Division of Pediatric Nephrology, Ankara, Turkey
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117
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Godman B, Haque M, McKimm J, Abu Bakar M, Sneddon J, Wale J, Campbell S, Martin AP, Hoxha I, Abilova V, Anand Paramadhas BD, Mpinda-Joseph P, Matome M, de Lemos LLP, Sefah I, Kurdi A, Opanga S, Jakupi A, Saleem Z, Hassali MA, Kibuule D, Fadare J, Bochenek T, Rothe C, Furst J, Markovic-Pekovic V, Bojanić L, Schellack N, Meyer JC, Matsebula Z, Phuong TNT, Thanh BN, Jan S, Kalungia A, Mtapuri-Zinyowera S, Sartelli M, Hill R. Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future. Curr Med Res Opin 2020; 36:301-327. [PMID: 31794332 DOI: 10.1080/03007995.2019.1700947] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use.Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known.Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals.Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Health Economics Centre, University of Liverpool, Liverpool, UK
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Wales UK
| | - Muhamad Abu Bakar
- Unit of Otolaryngology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Janney Wale
- Independent Consumer Advocate, Brunswick, Victoria, Australia
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Antony P Martin
- Health Economics Centre, University of Liverpool, Liverpool, UK
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Vafa Abilova
- Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan Republic
| | | | - Pinkie Mpinda-Joseph
- Department of Infection Prevention and Control, Nyangabgwe Hospital, Francistown, Botswana
| | | | - Livia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Campus Pampulha, Minas Gerais, CEP, Brazil
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, CEP, Brazil
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Sylvia Opanga
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
| | | | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Celia Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Jurij Furst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Ljubica Bojanić
- Public Health Institute, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Thuy Nguyen Thi Phuong
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Saira Jan
- Department of Clinical Pharmacy, Rutgers State University of New Jersey, Piscataway, NJ, USA
- Department of Pharmacy Strategy and Clinical Integration, Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | | | - Massimo Sartelli
- Department of Surgery, University of Macerata, Macerata Hospital, Macerata, MC, Italy
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, UK
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118
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Del Borrello G, Stocchero M, Giordano G, Pirillo P, Zanconato S, Da Dalt L, Carraro S, Esposito S, Baraldi E. New insights into pediatric community-acquired pneumonia gained from untargeted metabolomics: A preliminary study. Pediatr Pulmonol 2020; 55:418-425. [PMID: 31821737 PMCID: PMC7168041 DOI: 10.1002/ppul.24602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 12/02/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Available diagnostics often fail to distinguish viral from bacterial causes of pediatric community-acquired pneumonia (pCAP). Metabolomics, which aims at characterizing diseases based on their metabolic signatures, has been applied to expand pathophysiological understanding of many diseases. In this exploratory study, we used the untargeted metabolomic analysis to shed new light on the etiology of pCAP. METHODS Liquid chromatography coupled with mass spectrometry was used to quantify the metabolite content of urine samples collected from children hospitalized for CAP of pneumococcal or viral etiology, ascertained using a conservative algorithm combining microbiological and biochemical data. RESULTS Fifty-nine children with CAP were enrolled over 16 months. Pneumococcal and viral cases were distinguished by means of a multivariate model based on 93 metabolites, 20 of which were identified and considered as putative biomarkers. Among these, six metabolites belonged to the adrenal steroid synthesis and degradation pathway. CONCLUSIONS This preliminary study suggests that viral and pneumococcal pneumonia differently affect the systemic metabolome, with a stronger disruption of the adrenal steroid pathway in pneumococcal pneumonia. This finding may lead to the discovery of novel diagnostic biomarkers and bring us closer to personalized therapy for pCAP.
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Affiliation(s)
| | - Matteo Stocchero
- Department of Women's and Children's Health, University of Padova, Padova, Italy.,Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
| | - Giuseppe Giordano
- Department of Women's and Children's Health, University of Padova, Padova, Italy.,Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
| | - Paola Pirillo
- Department of Women's and Children's Health, University of Padova, Padova, Italy.,Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
| | - Stefania Zanconato
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Liviana Da Dalt
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Carraro
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Susanna Esposito
- Department of Surgical and Biomedical Sciences, Pediatric Clinic, University of Perugia, Perugia, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, University of Padova, Padova, Italy.,Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
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Population-based assessment of patient and provider characteristics influencing pediatric outpatient antibiotic use in a high antibiotic-prescribing state. Infect Control Hosp Epidemiol 2020; 41:331-336. [PMID: 31937378 DOI: 10.1017/ice.2019.338] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To identify patient and provider characteristics associated with high-volume antibiotic prescribing for children in Tennessee, a state with high antibiotic utilization. DESIGN Cross-sectional, retrospective analysis of pediatric (aged <20 years) outpatient antibiotic prescriptions in Tennessee using the 2016 IQVIA Xponent (formerly QuintilesIMS) database. METHODS Patient and provider characteristics, including county of prescription fill, rural versus urban county classification, patient age group, provider type (nurse practitioner, physician assistant, physician, or dentist), physician specialty, and physician years of practice were analyzed. RESULTS Tennessee providers wrote 1,940,011 pediatric outpatient antibiotic prescriptions yielding an antibiotic prescribing rate of 1,165 per 1,000 population, 50% higher than the national pediatric antibiotic prescribing rate. Mean antibiotic prescribing rates varied greatly by county (range, 39-2,482 prescriptions per 1,000 population). Physicians wrote the greatest number of antibiotic prescriptions (1,043,030 prescriptions, 54%) of which 56% were written by general pediatricians. Pediatricians graduating from medical school prior to 2000 were significantly more likely than those graduating after 2000 to be high antibiotic prescribers. Overall, 360 providers (1.7% of the 21,798 total providers in this dataset) were responsible for nearly 25% of both overall and broad-spectrum antibiotic prescriptions; 20% of these providers practiced in a single county. CONCLUSIONS Fewer than 2% of providers account for 25% of pediatric antibiotic prescriptions. High antibiotic prescribing for children in Tennessee is associated with specific patient and provider characteristics that can be used to design stewardship interventions targeted to the highest prescribing providers in specific counties and specialties.
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Kryukov AI, Gurov AV, Izotova GN, Lapenko EG. [Results of the observational (non-interventional) research 'Analysis of therapeutic efficiency of the polyvalent Piobacteriophag (Secstaphag) in the treatment of acute sinusitis']. Vestn Otorinolaringol 2020; 84:55-60. [PMID: 31793528 DOI: 10.17116/otorino20198405155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
He article describes an observational (non-intervening) research 'Analysis of the therapeutic efficacy of the Polyvalent Piobacteriophage (secstafag) in the treatment of acute sinusitis'. The obtained results prove the effectiveness of the drug in the treatment of this ENT pathology.
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Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152; Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia, 117997
| | - A V Gurov
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152; Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia, 117997
| | - G N Izotova
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152
| | - E G Lapenko
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152
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121
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Wushouer H, Wang Z, Tian Y, Zhou Y, Zhu D, Vuillermin D, Shi L, Guan X. The impact of physicians' knowledge on outpatient antibiotic use: Evidence from China's county hospitals. Medicine (Baltimore) 2020; 99:e18852. [PMID: 32011504 PMCID: PMC7220442 DOI: 10.1097/md.0000000000018852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We designed this study to explore how factors, especially knowledge, influence the use and prescriptions of antibiotics among physicians in China's county hospitals.A questionnaire was designed to evaluate the knowledge levels of physicians. The rates of antibiotic prescriptions were collected through on-the-spot investigations. The percentage of encounters with antibiotics prescribed and the percentage of encounters with antibiotics combination prescribed were used to measure antibiotics use. Univariate analysis and the generalized linear model were applied to analyze the knowledge levels among physicians as well as their antibiotic prescriptions.A total of 334 physicians in 60 county hospitals filled out the questionnaires, and 385,529 prescriptions were collected. The mean score of the questionnaire was a pass (62.8). The physicians in the eastern region of China demonstrated higher levels of knowledge than other regions (P = .08). Physicians with a higher score prescribed less antibiotics (P < .01) and less antibiotics combination (P = .07).The knowledge gap of Chinese physicians is evident and those with a higher degree of knowledge always prescribe fewer antibiotics. Targeted training and courses to educate physicians about the risks of over-prescription of antibiotics should be conducted to improve the practice of antibiotic prescriptions.
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Affiliation(s)
- Haishaerjiang Wushouer
- Center for Strategic Studies, Chinese Academy of Engineering,
- School of Medicine, Tsinghua University,
- International Research Center for Medicinal Administration, Peking University,
| | - Zhuangfei Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University,
| | - Ye Tian
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University,
| | - Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University,
| | - Dawei Zhu
- International Research Center for Medicinal Administration, Peking University,
- China Center for Health Development Studies, Peking University,
| | | | - Luwen Shi
- International Research Center for Medicinal Administration, Peking University,
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University,
| | - Xiaodong Guan
- International Research Center for Medicinal Administration, Peking University,
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University,
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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122
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Islam S, Mannix MK, Breuer RK, Hassinger AB. Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department. Clin Pediatr (Phila) 2020; 59:21-30. [PMID: 31609128 DOI: 10.1177/0009922819879462] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pediatric antibiotic prescriptions originate from an increasingly broad range of ambulatory settings. In this retrospective study, pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infection cases, at 11 primary care offices, 2 independent urgent care centers (UCCs), and a pediatric emergency department in Western New York, were analyzed relative to medical society practice guidelines and antibiotic utilization. Of 2358 eligible visits across all sites, 25% were for study diagnoses, with 38% at UCC (P < .01). Across all sites, 26% of pharyngitis cases given antibiotics did not have diagnostic evidence of bacterial infection. At primary care offices and UCCs, guideline recommended first-line agents for pharyngitis and otitis media were used in only 58% and 63% of treated cases, respectively. Overall, an estimated 9855 to 12 045 avoidable antibiotic and 8030 non-guideline antibiotic courses annually are represented by the 14 sites studied. These and other study findings highlight numerous opportunities for outpatient pediatric antibiotic stewardship.
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Affiliation(s)
- Shamim Islam
- Pediatric Infectious Diseases, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Mary Kathryn Mannix
- Pediatric Infectious Diseases, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ryan K Breuer
- John R. Oishei Children's Hospital, Buffalo, NY, USA.,Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Amanda B Hassinger
- John R. Oishei Children's Hospital, Buffalo, NY, USA.,Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, USA
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123
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Stockert K. Allergie, Mikrobiom und weitere epigenetische Faktoren. ALLERGIEPRÄVENTION 2020. [PMCID: PMC7123400 DOI: 10.1007/978-3-662-58140-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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124
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Giles AB, Sarbacker GB, Anderson K, King C, Goodbar N, Shealy K. Evaluation of Antibiotic Utilization in a Rural, Outpatient Clinic: An Antimicrobial Stewardship Initiative. J Pharm Pract 2019; 34:703-709. [PMID: 31884876 DOI: 10.1177/0897190019896498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Antibiotics are commonly prescribed for uncomplicated urinary tract infection (UTI) and acute otitis media (AOM) and may be unnecessary at times. The aim of this study was to evaluate prescribing practices for UTIs and AOM in a rural ambulatory care setting and to identify areas for improvement. METHODS In a single-center, retrospective review conducted at a rural clinic, patients diagnosed with uncomplicated UTI and AOM were included. Patients were identified by International Classification of Diseases, Tenth (ICD-10) codes, and data were collected for visits between January 1, 2017, and December 31, 2017. The primary outcome was to assess adherence of antimicrobial prescribing to current treatment guidelines. RESULTS Of the 76 patients identified, 28 met inclusion criteria. Of the 28 patients, 75% received an agent recommended first line in the treatment guidelines, and 18 of the 21 received a recommended dose. Only 17% of patients were prescribed an appropriate duration of treatment. CONCLUSION Opportunities exist for antimicrobial stewardship interventions for uncomplicated UTIs and AOM. Prescribers are not consistently adhering to guidelines in regard to antibiotic choice, dose, or duration. Additional education and stewardship interventions are crucial considering the increased prevalence of antimicrobial resistance.
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Affiliation(s)
- Amber B Giles
- Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, USA.,Medical Science Liaison, Janssen Scientific Affairs, LLC, NJ, USA
| | - G Blair Sarbacker
- Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, USA
| | | | - Courtney King
- Presbyterian College School of Pharmacy, Clinton, SC, USA
| | | | - Kayce Shealy
- Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, USA
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Roubaud-Baudron C, Ruiz VE, Swan AM, Vallance BA, Ozkul C, Pei Z, Li J, Battaglia TW, Perez-Perez GI, Blaser MJ. Long-Term Effects of Early-Life Antibiotic Exposure on Resistance to Subsequent Bacterial Infection. mBio 2019; 10:e02820-19. [PMID: 31874917 PMCID: PMC6935859 DOI: 10.1128/mbio.02820-19] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 12/22/2022] Open
Abstract
Early-life antibiotic exposure may provoke long-lasting microbiota perturbation. Since a healthy gut microbiota confers resistance to enteric pathogens, we hypothesized that early-life antibiotic exposure would worsen the effects of a bacterial infection encountered as an adult. To test this hypothesis, C57BL/6 mice received a 5-day course of tylosin (macrolide), amoxicillin (β-lactam), or neither (control) early in life and were challenged with Citrobacter rodentium up to 80 days thereafter. The early-life antibiotic course led to persistent alterations in the intestinal microbiota and even with pathogen challenge 80 days later worsened the subsequent colitis. Compared to exposure to amoxicillin, exposure to tylosin led to greater disease severity and microbiota perturbation. Transferring the antibiotic-perturbed microbiota to germfree animals led to worsened colitis, indicating that the perturbed microbiota was sufficient for the increased disease susceptibility. These experiments highlight the long-term effects of early-life antibiotic exposure on susceptibility to acquired pathogens.IMPORTANCE The gastrointestinal microbiota protects hosts from enteric infections; while antibiotics, by altering the microbiota, may diminish this protection. We show that after early-life exposure to antibiotics host susceptibility to enhanced Citrobacter rodentium-induced colitis is persistent and that this enhanced disease susceptibility is transferable by the antibiotic-altered microbiota. These results strongly suggest that early-life antibiotics have long-term consequences on the gut microbiota and enteropathogen infection susceptibility.
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Affiliation(s)
- Claire Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France
- University of Bordeaux, INSERM, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, Bordeaux, France
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Victoria E Ruiz
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
- Department of Biology, St. Francis College, Brooklyn, New York, USA
| | - Alexander M Swan
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Bruce A Vallance
- Division of Gastroenterology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ceren Ozkul
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
- Department of Pharmaceutical Microbiology, Hacettepe University School of Pharmacy, Ankara, Turkey
| | - Zhiheng Pei
- Department of Pathology, New York University Langone Medical Center, New York, New York, USA
| | - Jackie Li
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Thomas W Battaglia
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | | | - Martin J Blaser
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
- Center for Advanced Biotechnology and Medicine, Rutgers University, New Brunswick, NJ, USA
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126
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Schot MJC, Dekker ARJ, van Werkhoven CH, van der Velden AW, Cals JWL, Broekhuizen BDL, Hopstaken RM, de Wit NJ, Verheij TJM. Burden of disease in children with respiratory tract infections in primary care: diary-based cohort study. Fam Pract 2019; 36:723-729. [PMID: 31166598 PMCID: PMC7006994 DOI: 10.1093/fampra/cmz024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) are a common reason for children to consult in general practice. Antibiotics are often prescribed, in part due to miscommunication between parents and GPs. The duration of specific respiratory symptoms has been widely studied. Less is known about illness-related symptoms and the impact of these symptoms on family life, including parental production loss. Better understanding of the natural course of illness-related symptoms in RTI in children and impact on family life may improve GP-parent communication during RTI consultations. OBJECTIVE To describe the general impact of RTI on children and parents regarding illness-related symptoms, absenteeism from childcare, school and work, use of health care facilities, and the use of over-the-counter (OTC) medication. METHODS Prospectively collected diary data from two randomized clinical trials in children with RTI in primary care (n = 149). Duration of symptoms was analysed using survival analysis. RESULTS Disturbed sleep, decreased intake of food and/or fluid, feeling ill and/or disturbance at play or other daily activities are very common during RTI episodes, with disturbed sleep lasting longest. Fifty-two percent of the children were absent for one or more days from childcare or school, and 28% of mothers and 20% of fathers reported absence from work the first week after GP consultation. Re-consultation occurred in 48% of the children. OTC medication was given frequently, particularly paracetamol and nasal sprays. CONCLUSION Appreciation of, and communication about the general burden of disease on children and their parents, may improve understanding between GPs and parents consulting with their child.
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Affiliation(s)
- M J C Schot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A R J Dekker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C H van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A W van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J W L Cals
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - R M Hopstaken
- Star-shl diagnostic centers, Etten-Leur, The Netherlands
| | - N J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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127
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Meropol SB, Jacobs MR, Stange KC, Bajaksouzian S, Bonomo RA. Longitudinal Colonization With Streptococcus pneumoniae During the First Year of Life in a Healthy Newborn Cohort. J Pediatric Infect Dis Soc 2019; 9:442-448. [PMID: 31670814 PMCID: PMC7495909 DOI: 10.1093/jpids/piz068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 09/12/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND The objective of this study was to characterize longitudinal colonization with Streptococcus pneumoniae during the first year of life within a community newborn infant cohort, and assess the relationship between antibiotic exposure and colonization with antibiotic-resistant organisms. METHODS During April 2013-February 2014, 326 infants were enrolled from an urban academic hospital well-baby nursery. At ages 4, 8, and 12 months, we collected antibiotic data, other exposure data, and nasopharyngeal cultures for pneumococcal isolation. RESULTS Follow-up visits were completed for 211, 158, and 144 infants at ages 4, 8, and 12 months, respectively. By 12 months, 33% of infants attending the visits had ever been exposed to antibiotics, 67% if exposures to maternal antibiotics at birth are included. Pneumococci were isolated at 38/839 (4.5%) visits from 38 infants, including one 13-valent conjugate vaccine (PCV13) serotype (6A). There were 1 (0.3%), 15 (7%), 7 (4%), and 15 (10%) infants who were colonized at 0-, 4-, 8-, and 12-month visits, respectively. By age 12 months, at least 35 (11%) infants had ever been colonized. Sixteen isolates (42%) exhibited nonsusceptibility to at least 1 antibiotic. Infants with recent antibiotic exposure were not more likely to be colonized or to harbor nonsusceptible organisms. CONCLUSIONS Within a hospital birth cohort followed in the community, pneumococcal colonization and related antibiotic resistance were lower than previously reported, likely associated with PCV13 use. Antibiotic exposure was not associated with subsequent colonization with resistant isolates. The influence of other environmental factors needs further study.
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Affiliation(s)
- Sharon B Meropol
- Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Department of Population and Quantitative Health Sciences, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Center for Child Health and Policy, Case Western Reserve School of Medicine, Rainbow Babies and Children’s Hospital, and University Hospitals of Cleveland, Cleveland, Ohio, USA,Correspondence: Sharon B. Meropol, Department of Population Health, New York University School of Medicine, 180 Madison Ave, New York, NY 10016 ()
| | - Michael R Jacobs
- Department of Pathology, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Department of Family Medicine & Community Health, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Case Comprehensive Cancer Center, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Department of Sociology, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Center for Community Health Integration, Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Saralee Bajaksouzian
- Department of Pathology, Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Department of Pharmacology, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Department of Molecular Biology and Microbiology, Case Western Reserve School of Medicine, Cleveland, Ohio, USA,Louis Stokes Cleveland Veterans Affairs Medical Center Cleveland, Ohio, USA
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128
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Aoybamroong N, Kantamalee W, Thadanipon K, Techasaensiri C, Malathum K, Apiwattanakul N. Impact of an Antibiotic Stewardship Program on Antibiotic Prescription for Acute Respiratory Tract Infections in Children: A Prospective Before-After Study. Clin Pediatr (Phila) 2019; 58:1166-1174. [PMID: 31431068 DOI: 10.1177/0009922819870248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed the effectiveness of an antibiotic stewardship program (ASP) on antibiotic prescriptions for acute respiratory tract infection (ARTI) in a medical school. Our ASP included delivering an antibiotic use guideline via e-mail and LINE (an instant messaging app) to faculty staff, fellows, and residents, and posting of the guideline in examination rooms. Medical records of pediatric patients diagnosed with ARTI were reviewed to assess the appropriateness of antibiotic prescription. ASP could increase the rate of appropriateness from 78% (1979 out of 2553 visits) to 83.4% (2449 out of 2935 visits; P < .001). The baseline of appropriateness was higher in residents (95%) compared with fellows (82%) and faculty staff (75%). The ASP significantly increased the appropriateness only in faculty staff, especially in semiprivate clinics (75% to 83%, P < .001). In conclusion, our ASP increased appropriateness of antibiotic prescriptions for ARTI, with the greatest impact among faculty staff in semiprivate clinics.
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129
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Agiro A, Sridhar G, Gordon A, Brown J, Haynes K. Antibiotic dispensing following pediatric visits in the US emergency departments and outpatient settings from 2006 to 2016. Pharmacol Res Perspect 2019; 7:e00512. [PMID: 31467679 PMCID: PMC6711353 DOI: 10.1002/prp2.512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 01/21/2023] Open
Abstract
This study measured rates and trends in antibiotic dispensing for emergency department (ED) and outpatient visits by age groups. This retrospective analysis used data from the National Institutes of Health Collaboratory Distributed Research Network. The analysis included children (aged > 3 months to <12 years) and adolescents (aged 12 to <19 years) with or without an antibiotic dispensed within 3 days following visits for infectious diagnoses occurring from 2006 to 2016, with no antibiotic fills 90 days prior. Diagnoses were classified as: 1) respiratory tract infections (RTIs) for which antibiotics are mostly indicated; 2) RTIs for which antibiotics are mostly not indicated; 3) respiratory conditions for which antibiotics are never indicated; 4) infectious conditions beyond RTIs regardless of antibiotic indication. The largest annual decrease in any dispensed antibiotics (5% per year) was seen in ED visits for not indicated RTIs and never indicated respiratory conditions (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI] 0.95-0.96). In outpatient settings, a 2% per year decrease was seen for not indicated RTIs and never indicated respiratory conditions (IRR 0.98, 95% CI 0.98-0.98). Broad-spectrum antibiotics had a 1% per year increase in outpatient settings for mostly indicated RTIs (IRR 1.01, 95% CI 1.01-1.01). Compared with adolescents, broad-spectrum antibiotic dispensing rates and trends were consistently higher for children regardless of diagnosis or care setting. Using national claims data, this real-world analysis found uneven decreases in potentially inappropriate antibiotic dispensing, suggesting the need for antibiotic stewardship interventions to become more common in outpatient settings.
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Affiliation(s)
- Abiy Agiro
- Translational Research for Affordability and Quality, HealthCoreWilmingtonDE
| | - Gayathri Sridhar
- Translational Research for Affordability and Quality, HealthCoreWilmingtonDE
| | - Aliza Gordon
- Translational Research for Affordability and Quality, HealthCoreWilmingtonDE
| | | | - Kevin Haynes
- Translational Research for Affordability and Quality, HealthCoreWilmingtonDE
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130
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O'Keefe C, Thompson A, McKenzie D, Lee K. Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior-to-hospital therapy. Int J Clin Pract 2019; 73:e13427. [PMID: 31573741 DOI: 10.1111/ijcp.13427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 08/12/2019] [Accepted: 09/21/2019] [Indexed: 11/30/2022] Open
Abstract
Background Appropriate antibiotic prescribing improves patient outcomes and mitigates antimicrobial resistance. As the majority of antibiotics are used in the community, rational prescribing in this setting is of paramount importance. Objectives We aimed to (1) evaluate the concordance of community antibiotic prescribing with guidelines for three common infection types among patients who presented to hospital, and (2) identify relationships between guideline concordance and patient-related factors. Methods Medical records were evaluated from the Royal Hobart Hospital (Tasmania, Australia) for patients presenting with respiratory tract, urinary tract or skin and soft tissue infections within a 12-month period. Prior-to-hospital antibiotic therapy was assessed for concordance with prescribing guidelines based on presenting diagnosis. Concordance was assessed against first-line recommendations in the Australian Therapeutic Guidelines - Antibiotic, based on drug choice, dose, frequency and patient factors. Descriptive statistics were performed to address Objective 1. Multivariate logistic regressions were conducted to address Objective 2 with the following independent variables: infection type, age, allergies, diabetes status, gender and residential setting. Results A total of 285 patient records were eligible for data analysis; 28.8% (n = 82) were fully guideline concordant. The most common reason for non-concordance was inappropriate drug choice (n = 143, 50.2%). Patients with the following characteristics were less likely to receive concordant therapy: diabetes (OR = 0.3, 95% CI 0.1-0.8, P = .02) and increasing age (OR = 0.99, 95% CI 0.98-1.00, P = .04). Conclusions Almost three-quarters of patients received community-initiated antibiotic therapy that was not fully guideline concordant. Antimicrobial stewardship interventions are urgently needed to improve guideline concordance for community-initiated antibiotic therapy.
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Affiliation(s)
- Caitlan O'Keefe
- Pharmacy Department, Tasmanian Health Service, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Angus Thompson
- Division of Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Duncan McKenzie
- Pharmacy Department, Tasmanian Health Service, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Faculty of Health and Medical Sciences, Division of Pharmacy, School of Allied Health, University of Western Australia, Crawley, Western Australia, Australia
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131
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Grammatico-Guillon L, Abdurrahim L, Shea K, Astagneau P, Pelton S. Scope of Antibiotic Stewardship Programs in Pediatrics. Clin Pediatr (Phila) 2019; 58:1291-1301. [PMID: 31179745 DOI: 10.1177/0009922819852985] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review of pediatric antibiotic stewardship programs (ASPs) summarized the antibiotic prescribing interventions and their impact on antibiotic use and antimicrobial resistance. We reviewed studies of pediatric ASP, including the search terms "antimicrobial stewardship," "antibiotic stewardship," "children," and "pediatric." The articles' selection and review were performed independently by 2 investigators, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Twenty-one studies were included, from the past 15 years, increasing after the 2007 IDSA (Infectious Diseases Society of America) guidelines for ASP with a large variability of the programs, and the virtual exclusive focus on inpatient settings (90%): 16 formalized ASP and 5 non-ASP actions. A reduction in antibiotic prescribing in ASP has been demonstrated in the studies reporting pediatric ASP, but only one ASP showed a significant impact on antimicrobial resistance. However, the impact on antibiotic consumption in pediatrics demonstrated the important contribution of these strategies to improve antibiotic use in children, without complications or negative issues.
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Affiliation(s)
| | | | | | - Pascal Astagneau
- APHP University Hospital, Paris, France.,Sorbonne University, Paris France
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132
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Eilermann K, Halstenberg K, Kuntz L, Martakis K, Roth B, Wiesen D. The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence. Med Decis Making 2019; 39:781-795. [PMID: 31423892 PMCID: PMC6843625 DOI: 10.1177/0272989x19866699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Inappropriate prescribing of antibiotics, which is common in pediatric care, is a key driver of antimicrobial resistance. To mitigate the development of resistance, antibiotic stewardship programs often suggest the inclusion of feedback targeted at individual providers. Empirically, however, it is not well understood how feedback affects individual physicians’ antibiotic prescribing decisions. Also, the question of how physicians’ characteristics, such as clinical experience, relate to antibiotic prescribing decisions and to responses to feedback is largely unexplored. Objective. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians’ antibiotic prescribing decisions in pediatrics. Design. We employed a randomized, controlled framed field experiment, in which German pediatricians (n=73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group (n=39), pediatricians received descriptive feedback in form of an expert benchmark, which allowed them to compare their own prescribing decisions with expert recommendations. The recommendations were elicited in a survey of pediatric department directors (n=20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians’ characteristics were elicited in a comprehensive questionnaire. Results. Providing pediatricians with expert feedback significantly reduced the length of antibiotic therapies by 10% on average. Also, the deviation of pediatricians’ decisions from experts’ recommendations significantly decreased. Antibiotic therapy decisions were significantly related to pediatricians’ clinical experience, risk attitudes, and personality traits. The effect of feedback was significantly associated with physicians’ experience. Conclusion. Our results indicate that descriptive expert feedback can be an effective means to guide pediatricians, especially those who are inexperienced, toward more appropriate antibiotic prescribing. Therefore, it seems to be suitable for inclusion in antibiotic stewardship programs.
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Affiliation(s)
- Kerstin Eilermann
- Cologne Graduate School in Management, Economics, and Social Sciences (CGS), Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Katrin Halstenberg
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- />Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
- />Operations Management Group, Judge Business School, University of Cambridge, Cambridge, UK
| | - Kyriakos Martakis
- />Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
- />Department of International Health, Care and Public Health Research Institute, School CAPHRI, Maastricht University, Maastricht, the Netherlands
- />Department of Pediatric Neurology, University Children’s Hospital (UKGM) and Medical Faculty, Justus Liebig University of Giessen, Giessen, Germany
| | - Bernhard Roth
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
| | - Daniel Wiesen
- Daniel Wiesen, Department of Business Administration and Health Care Management, University of Cologne, Albertus-Magnus-Platz, Cologne, 50923, Germany ()
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Sturød K, Dhariwal A, Dahle UR, Vestrheim DF, Petersen FC. Impact of narrow-spectrum penicillin V on the oral and faecal resistome in a young child treated for otitis media. J Glob Antimicrob Resist 2019; 20:290-297. [PMID: 31415828 DOI: 10.1016/j.jgar.2019.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Antibiotic overuse has led to the global emergence of antimicrobial-resistant bacteria, and children are among the most frequent users of antibiotics. Most studies with broad-spectrum antibiotics show a severe impact on resistome development in patients. Although narrow-spectrum antibiotics are believed to have fewer side effects, their impact on the microbiome and resistome is mostly unknown. The aim of this study was to investigate the impact of the narrow-spectrum antibiotic phenoxymethylpenicillin (penicillin V) on the microbiome and resistome of a child treated for acute otitis media. METHODS Oral and faecal samples were collected from a 1-year-old child before (Day 0) and after (Days 5 and 30) receiving penicillin V for otitis media. Metagenomic sequencing data were analysed to determine taxonomic profiling using Kraken and Bracken software, and resistance profiling using KMA in combination with the ResFinder database. RESULTS In the oral samples, antimicrobial resistance genes (ARGs) belonging to four classes were identified at baseline. At Day 5, the abundance of some ARGs was increased, whereas some remained unchanged and others could no longer be detected. At Day 30, most ARGs had returned to baseline levels or lower. In the faecal samples, seven ARGs were observed at baseline and five at Day 5. At Day 30, the number of ARGs had increased to 21. CONCLUSIONS Following penicillin V, we observed a remarkable enrichment of the aecal resistome, indicating that even narrow-spectrum antibiotics may have important consequences in selecting for a more resistant microbiome.
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Affiliation(s)
- Kjersti Sturød
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Achal Dhariwal
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ulf R Dahle
- Centre for Antimicrobial Resistance, Norwegian Institute of Public Health, Oslo, Norway
| | - Didrik F Vestrheim
- Centre for Antimicrobial Resistance, Norwegian Institute of Public Health, Oslo, Norway
| | - Fernanda C Petersen
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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Gómez-Carballa A, Cebey-López M, Pardo-Seco J, Barral-Arca R, Rivero-Calle I, Pischedda S, Currás-Tuala MJ, Gómez-Rial J, Barros F, Martinón-Torres F, Salas A. A qPCR expression assay of IFI44L gene differentiates viral from bacterial infections in febrile children. Sci Rep 2019; 9:11780. [PMID: 31409879 PMCID: PMC6692396 DOI: 10.1038/s41598-019-48162-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022] Open
Abstract
The diagnosis of bacterial infections in hospital settings is currently performed using bacterial culture from sterile site, but they are lengthy and limited. Transcriptomic biomarkers are becoming promising tools for diagnosis with potential applicability in clinical settings. We evaluated a RT-qPCR assay for a 2-transcript host expression signature (FAM89A and IFI44L genes) inferred from microarray data that allow to differentiate between viral and bacterial infection in febrile children. This assay was able to discriminate viral from bacterial infections (P-value = 1.04 × 10-4; AUC = 92.2%; sensitivity = 90.9%; specificity = 85.7%) and showed very high reproducibility regardless of the reference gene(s) used to normalize the data. Unexpectedly, the monogenic IFI44L expression signature yielded better results than those obtained from the 2-transcript test (P-value = 3.59 × 10-5; AUC = 94.1%; sensitivity = 90.9%; specificity = 92.8%). We validated this IFI44L signature in previously published microarray and whole-transcriptome data from patients affected by different types of viral and bacterial infections, confirming that this gene alone differentiates between both groups, thus saving time, effort, and costs. Herein, we demonstrate that host expression microarray data can be successfully translated into a fast, highly accurate and relatively inexpensive in vitro assay that could be implemented in the clinical routine.
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Affiliation(s)
- Alberto Gómez-Carballa
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain.
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
- Unidade de Xenética, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain.
| | - Miriam Cebey-López
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Jacobo Pardo-Seco
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Unidade de Xenética, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain
| | - Ruth Barral-Arca
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Irene Rivero-Calle
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sara Pischedda
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - María José Currás-Tuala
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Gómez-Rial
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Barros
- Unidad de Medicina Molecular, Fundación Pública Galega de Medicina Xenómica, CIBERER, Santiago de Compostela, Spain
| | - Federico Martinón-Torres
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Salas
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Unidade de Xenética, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain
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Impact of Education and Peer Comparison on Antibiotic Prescribing for Pediatric Respiratory Tract Infections. Pediatr Qual Saf 2019; 4:e195. [PMID: 31572896 PMCID: PMC6708653 DOI: 10.1097/pq9.0000000000000195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/19/2019] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Inappropriate prescribing of broad-spectrum antibiotics is a significant modifiable risk factor for the development of antibiotic resistance. The objective was to improve guideline-concordant care for 3 common acute respiratory tract infections (ARTIs) and to reduce broad-spectrum antibiotic prescribing in ambulatory pediatric patients. Methods: Quality measures were developed for 3 ARTIs: viral upper respiratory infection (URI), acute bacterial sinusitis (ABS), and acute otitis media (AOM). Among 22 pediatric clinics, a collaborative of 10 was identified for intervention using baseline data for each ARTI, and 3 plan-do-study-act cycles were planned and completed. Outcomes included guideline-concordant antibiotic utilization and broad-spectrum antibiotic prescribing percentage (BSAP%). Comparison in number of diagnoses for the ARTI measures and total antibiotic prescribing over time served as balancing measures. Results: Collaborative clinics had baseline medians for appropriate or first-line treatment of 70% for URI, 53% for ABS, and 36% for AOM. To reach targets for URI, ABS, and AOM required 6, 14, and 18 months, respectively. At 42 months, performance for all 3 ARTIs remained ≥90%. BSAP% decreased from a baseline of 57% to 34% at 24 months. There was a limited effect from financial incentives but a significant decrease was noted in total antibiotic utilization. Diagnosis shifting may have occurred for URI and ABS while the rates for diagnoses for AOM declined over time. Conclusions: Through education and peer comparison feedback, guideline-concordant care for 3 ARTIs in collaborative clinics improved and remained beyond above targets and was accompanied by reductions in BSAP% and total antibiotic prescribing.
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Ni J, Friedman H, Boyd BC, McGurn A, Babinski P, Markossian T, Dugas LR. Early antibiotic exposure and development of asthma and allergic rhinitis in childhood. BMC Pediatr 2019; 19:225. [PMID: 31277618 PMCID: PMC6612173 DOI: 10.1186/s12887-019-1594-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of pediatric allergic diseases has increased rapidly in the United States over the past few decades. Recent studies suggest an association between the increase in allergic disease and early disturbances to the gut microbiome. The gut microbiome is a set of intestinal microorganisms that begins to form during birth and is highly susceptible to disturbance during the first year of life. Early antibiotic exposure may negatively impact the gut microbiota by altering the bacterial composition and causing dysbiosis, thus increasing the risk for developing childhood allergic disease. METHODS We performed a retrospective chart review of data in Loyola University Medical Center's (LUMC) Epic system from 2007 to 2016. We defined antibiotic exposure as orders in both the outpatient and inpatient settings. Inclusion criteria were being born at LUMC with at least two follow up visits. Asthma and allergic rhinitis diagnoses were obtained using ICD 9 and ICD 10 codes. We controlled for multiple confounding factors. Using Stata, bivariate logistic regression was performed between antibiotics from 0 to 12 months of life and development of disease. This analysis was repeated for total lifetime antibiotics. We defined statistically significant as p < .05. RESULTS The administration of antibiotics within the first 12 months of life was significantly associated with lifetime asthma (OR 2.66; C. I 1.11-6.40) but not allergic rhinitis. There was a significant association between lifetime antibiotics and asthma (OR 3.54; C. I 1.99-6.30) and allergic rhinitis (OR 2.43; C. I 1.43-4.11). CONCLUSION Antibiotic administration in the first year of life and throughout lifetime is significantly associated with developing asthma and allergic rhinitis. These results provide support for a conservative approach regarding antibiotic use in early childhood.
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Affiliation(s)
- Jeffrey Ni
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Hannah Friedman
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Bridget C. Boyd
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Andrew McGurn
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Piotr Babinski
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Talar Markossian
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Lara R. Dugas
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 USA
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137
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Shaver AL, Jacobs DM, LaMonte MJ, Noyes K. Antibiotic prescribing for acute respiratory tract infections in the United States outpatient setting. BMC FAMILY PRACTICE 2019; 20:91. [PMID: 31266449 PMCID: PMC6607511 DOI: 10.1186/s12875-019-0980-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/16/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute respiratory tract infections (ARIs) are common in the outpatient setting. Although they are predominantly viral, antibiotics are often prescribed for the treatment of ARIs. METHODS Using the U.S. Medical Expenditure Panel Survey (MEPS; 2010-2015), we estimated the national prevalence and predictors of outpatient antibiotic prescribing for ARIs by provider type. We categorized the trends of antibiotic prescriptions (overall or broad-spectrum) for ARIs by provider type (physician and advanced practice provider [APP] which includes nurse practitioner [NP], and physician assistant [PA]). The outcome variable was defined as receipt of an antibiotic prescription during a consultation with a provider for an ARI (including outpatient clinic visit or doctor's office visit). RESULTS There were 64,081,892 ARI antibiotic prescriptions written, with a decrease from 10.9 (2010) to 9.7 million (2015) during the study interval (p < 0.0001). Associations of patient- and provider-level variables with antibiotics prescription were examined using binary logistic regression. Blacks were more likely to receive antibiotics than whites (OR 1.51; 95% CI 1.25, 1.84; p < 0.001), and antibiotic prescription was more likely if the patient-provider race was concordant (OR 5.41; 95% CI 4.65, 6.29, p < 0.0001). Although the majority of patients with ARI were cared for by physicians, APPs were seeing an increasing number of ARI patients. CONCLUSIONS Antibiotic prescribing for ARIs though declining, remains high. More research is needed to better understand the drivers of ARI antibiotic prescribing and to develop targeted interventions for both patients and providers.
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Affiliation(s)
- Amy L Shaver
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 272 Farber Hall, South Campus, Buffalo, NY, 14260, USA.
| | - David M Jacobs
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 272 Farber Hall, South Campus, Buffalo, NY, 14260, USA
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 272 Farber Hall, South Campus, Buffalo, NY, 14260, USA
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138
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Zhang J, Chen Y, Cao L, Zhang R, Ren R, Zhang Q. Tuina for children with upper respiratory tract infections: A protocol for a systematic review. Medicine (Baltimore) 2019; 98:e16443. [PMID: 31305472 PMCID: PMC6641666 DOI: 10.1097/md.0000000000016443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Upper respiratory tract infections (URTIs) is a common disease in children, which is also known as the common cold. Pediatric Tuina is a common treatment that Traditional Chinese Medicine (TCM) doctors commonly use for URTIs. However, there has no relevant systematic review studied on its effects and safety been reported. We plan to perform a systematically reviewing of all the clinical evidence on the effectiveness and safety of Tuina for URTIs in children. METHODS We will conduct the literature searching in the following electronic databases: Pubmed, Embase, Cochrane Library, Web of science, Chinese National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biomedical Literature Database (CBM), Chinese Clinical Trial Registry System. The time limit for retrieving studies is from establishment to July 2019 for each database. All published randomized controlled trials (RTCs) related to this review will be included. Review Manager (V.5.3.5) will be implemented for the assessment of bias risk and data analyses. Subgroup analysis and sensitivity analysis will be performed based on the conditions of included data. RESULTS A high-quality synthesis of current evidence of Tuina for children with URTIs will be provided in this study. CONCLUSION This systematic review will provide evidence of whether Tuina is an effective intervention for children with URTIs. PROSPERO REGISTRATION NUMBER CRD42019126963.
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Affiliation(s)
- Jiayuan Zhang
- Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District
| | - Yunhui Chen
- Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District
| | - Liu Cao
- Sichuan Integrative Medicine Hospital, Wuhou District, Chengdu, Sichuan, China
| | - Renyan Zhang
- Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District
| | - Renyuan Ren
- Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District
| | - Qi Zhang
- Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District
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139
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Wolfson LJ, Castillo ME, Giglio N, Mészner Z, Molnár Z, Vàzquez M, Wysocki J, Altland A, Kuter BJ, Stutz M, Rampakakis E, Roberts CS. The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe. BMC Public Health 2019; 19:826. [PMID: 31242875 PMCID: PMC6595594 DOI: 10.1186/s12889-019-7071-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Varicella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation. Methods Pooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1–14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country. Results Four hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, β-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%. Conclusions High rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications. Electronic supplementary material The online version of this article (10.1186/s12889-019-7071-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara J Wolfson
- Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE), Kenilworth, NJ, USA.
| | - Marìa Esther Castillo
- Instituto Nacional de Salud del Niño (INSN), Breña, Perú.,Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Norberto Giglio
- Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Zsófia Mészner
- St. László Hospital for Infectious Diseases, National Institute of Child Health, Budapest, Hungary
| | | | | | - Jacek Wysocki
- Poznan University of Medical Sciences, Poznan, Poland
| | - Alexandra Altland
- Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE), Kenilworth, NJ, USA
| | - Barbara J Kuter
- Merck & Co., Inc., Global Vaccines Medical Affairs, Kenilworth, NJ, USA
| | | | - Emmanouil Rampakakis
- JSS Medical Research, Montréal, Québec, Canada.,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Craig S Roberts
- Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE), Kenilworth, NJ, USA
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Adrizain R, Setiabudi D, Chairulfatah A. The inappropriate use of antibiotics in hospitalized dengue virus-infected children with presumed concurrent bacterial infection in teaching and private hospitals in Bandung, Indonesia. PLoS Negl Trop Dis 2019; 13:e0007438. [PMID: 31226110 PMCID: PMC6608981 DOI: 10.1371/journal.pntd.0007438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 07/03/2019] [Accepted: 05/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics. METHODS A retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients' medical records admitted from January 1 to December 31, 2015. RESULTS There were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (p<0.0001 and p<0.05 respectively). The diagnosis of URTI in both teaching and private hospitals was merely based on clinical findings. Amoxicillin was given to 1 patient in the teaching hospitals; the 3rd generation of cephalosporins, mostly intravenous, were given in 247 (67%) cases in private hospitals. The diagnosis of typhoid fever in the teaching hospitals was based on culture in 1 (16.7%) and reactive IgM anti-Salmonella in 5 (83.3%) cases while in the private hospitals, they were based on reactive IgM anti-Salmonella in 13 (6.5%) cases, single Widal test in 61 (32.5%), and without laboratory confirmation in 114 (60.6%) cases. Most of the cases in both hospital settings were treated mostly with 3rd generation cephalosporin. The diagnosis of UTI was based on positive leucocyte esterase and nitrite in urine dipstick test in 7 (38.9%) and leucocyturia alone in 11 (61.1%) cases and was treated with 3rd generation in 15 (83.3%) cases, amoxicillin, chloramphenicol and clarithromycin, each in 1 (5.6%) case. CONCLUSION The use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics.
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Affiliation(s)
- Riyadi Adrizain
- Department of Child’s Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Djatnika Setiabudi
- Department of Child’s Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Alex Chairulfatah
- Department of Child’s Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Fishman E, Crawford G, DeVries A, Hackell J, Haynes K, Helm M, Wall E, Agiro A. Association between early-childhood antibiotic exposure and subsequent asthma in the US Medicaid population. Ann Allergy Asthma Immunol 2019; 123:186-192.e9. [PMID: 31158472 DOI: 10.1016/j.anai.2019.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although socioeconomically disadvantaged children have an increased risk of asthma, the association between early-childhood antibiotics and the incidence of asthma among such children has had limited study. OBJECTIVE To examine the association between antibiotic fills in the first 2 years of life and risk of developing asthma among children enrolled in Medicaid plans. METHODS This retrospective cohort study of children with continuous medical and pharmacy coverage from birth to 2.5 years of age was performed from July 1, 2012, to November 31, 2018. We excluded children with a diagnosis of asthma before 2.5 years of age. Hazard ratios (HRs) and 95% CIs were estimated from Cox proportional hazards regression models. Covariates included sex, preterm birth, cesarean delivery, and mother's asthma status. RESULTS There were 79,582 children in the study cohort of whom 29,931 (37.6%) had 0 antibiotic prescriptions filled, 27,403 (34.4%) had 1 or 2 prescriptions filled, and 22,248 (28.0%) had 3 or more prescriptions filled. A total of 2381 new cases of asthma were observed in 89,545 person-years of follow-up. After adjustment, receipt of 1 or 2 antibiotics was associated with an increased risk of developing asthma, relative to 0 antibiotics (HR, 1.34; 95% CI, 1.21-1.49), and receipt of 3 or more antibiotics was associated with greater increased risk relative to 0 antibiotics (HR, 1.71; 95% CI, 1.54-1.90). After adjustment, the absolute risk of developing asthma by age 4.0 years increased from 2.7% (0 antibiotics) to 3.6% (1-2 antibiotics) and 4.5% (≥3 antibiotics). CONCLUSION Antibiotic prescriptions filled in the first 2 years of life were associated with an increased risk of asthma diagnosis from 2.5 to 5 years of age in a Medicaid population.
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Affiliation(s)
| | | | | | | | | | - Mark Helm
- Childhood Health Associates of Salem, Salem, Oregon
| | - Eric Wall
- University of Washington Neighborhood Clinics, Seattle, Washington
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142
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Hamad AF, Alessi-Severini S, Mahmud SM, Brownell M, Kuo IF. Early childhood antibiotics use and autism spectrum disorders: a population-based cohort study. Int J Epidemiol 2019; 47:1497-1506. [PMID: 30101312 DOI: 10.1093/ije/dyy162] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 01/15/2023] Open
Abstract
Background Changes in microbiota composition as a result of antibiotics use in early life has been proposed as a possible contributor in the aetiology of autism spectrum disorders (ASD). We aimed to examine the association between early life antibiotic exposure and risk of ASD. Methods This was a population-based cohort study which included all live births in Manitoba, Canada, between 1 April 1998 and 31 March 2016. We used administrative health data from the Manitoba Population Research Data Repository. Exposure was defined as having filled one or more antibiotic prescription during the first year of life. The main outcome was ASD diagnosis. Cox proportional hazards regression models were used to estimate the risk of developing ASD in the overall population and in a sibling cohort. Results Of all subjects in the cohort (n = 214 834), 94 024 (43.8%) filled an antibiotic prescription during the first year of life. During follow-up, 2965 children received an ASD diagnosis. Compared with children who did not use antibiotics during the first year of life, those who received antibiotics had a reduced risk of ASD [adjusted hazardz ratio (HR) 0.91, 95% confidence interval (CI) 0.84-0.99). Number of treatment courses and cumulative duration of antibiotic exposure were not associated with ASD. In the sibling-controlled analysis, early life antibiotic exposure was not associated with ASD (adjusted HR 1.03, 95% CI 0.86-1.23). Conclusions Our findings suggested no clinically significant association between early life antibiotics exposure and risk of autism spectrum disorders, and should provide reassurance to concerned prescribers and parents.
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Affiliation(s)
- Amani F Hamad
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - I Fan Kuo
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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143
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Lyttle MD, Bielicki JA, Barratt S, Dunn D, Finn A, Harper L, Jackson P, Powell CVE, Roland D, Stohr W, Sturgeon K, Wan M, Little P, Faust SN, Robotham J, Hay AD, Gibb DM, Sharland M. Efficacy, safety and impact on antimicrobial resistance of duration and dose of amoxicillin treatment for young children with Community-Acquired Pneumonia: a protocol for a randomIsed controlled Trial (CAP-IT). BMJ Open 2019; 9:e029875. [PMID: 31123008 PMCID: PMC6538022 DOI: 10.1136/bmjopen-2019-029875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a common indication for antibiotic treatment in young children. Data are limited regarding the ideal dose and duration of amoxicillin, leading to practice variation which may impact on treatment failure and antimicrobial resistance (AMR). Community-Acquired Pneumonia: a randomIsed controlled Trial (CAP-IT) aims to determine the optimal amoxicillin treatment strategies for CAP in young children in relation to efficacy and AMR. METHODS AND ANALYSIS The CAP-IT trial is a multicentre, randomised, double-blind, placebo-controlled 2×2 factorial non-inferiority trial of amoxicillin dose and duration. Children are enrolled in paediatric emergency and inpatient environments, and randomised to receive amoxicillin 70-90 or 35-50 mg/kg/day for 3 or 7 days following hospital discharge. The primary outcome is systemic antibacterial treatment for respiratory tract infection (including CAP) other than trial medication up to 4 weeks after randomisation. Secondary outcomes include adverse events, severity and duration of parent-reported CAP symptoms, adherence and antibiotic resistance. The primary analysis will be by intention to treat. Assuming a 15% primary outcome event rate, 8% non-inferiority margin assessed against an upper one-sided 95% CI, 90% power and 15% loss to follow-up, 800 children will be enrolled to demonstrate non-inferiority for the primary outcome for each of duration and dose. ETHICS AND DISSEMINATION The CAP-IT trial and relevant materials were approved by the National Research Ethics Service (reference: 16/LO/0831; 30 June 2016). The CAP-IT trial results will be published in peer-reviewed journals, and in a report published by the National Institute for Health Research Health Technology Assessment programme. Oral and poster presentations will be given to national and international conferences, and participating families will be notified of the results if they so wish. Key messages will be constructed in partnership with families, and social media will be used in their dissemination. TRIAL REGISTRATION NUMBER ISRCTN76888927, EudraCT2016-000809-36.
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Affiliation(s)
- Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Julia A Bielicki
- Paediatric Infectious Diseases Research Group, MRC Clinical Trial Unit at UCL, Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - David Dunn
- MRC Clinical Trials Unit at UCL, London, UK
| | - Adam Finn
- Bristol Children's Vaccine Centre, Schools of Population Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | | | - Pauline Jackson
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Colin V E Powell
- Paediatric Emergency Medicine Department, Sidra Medicine, Doha, Qatar
- School of Medicine, Cardiff University, Cardiff, UK
| | - Damian Roland
- Emergency Department, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, UK
- SAPPHIRE group, University of Leicester Department of Health Sciences, Leicester, UK
| | | | | | - Mandy Wan
- NIHR CRN: Children, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Little
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Saul N Faust
- Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julie Robotham
- HCAI and AMR Division, National Infection Service, Public Health England, London, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | | | - Mike Sharland
- Paediatric Infectious Diseases Research Group, MRC Clinical Trial Unit at UCL, Institute for Infection and Immunity, St George's University of London, London, UK
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144
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Iida N, Mizukoshi E, Yamashita T, Terashima T, Arai K, Seishima J, Kaneko S. Overuse of antianaerobic drug is associated with poor postchemotherapy prognosis of patients with hepatocellular carcinoma. Int J Cancer 2019; 145:2701-2711. [PMID: 30980680 PMCID: PMC6766885 DOI: 10.1002/ijc.32339] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/15/2019] [Accepted: 04/08/2019] [Indexed: 12/24/2022]
Abstract
Overuse of antibiotic drugs alters the composition of gut microbiota and has detrimental effects on the host. In our study, we investigated association of gut flora and antibiotics in the prognosis of patients with liver cancer who have undergone chemotherapy by analyzing two independent clinical studies. We retrospectively subanalyzed a previously reported randomized controlled trial (RCT) on hepatic arterial infusion chemotherapy in patients with hepatocellular carcinoma (HCC) to investigate the association between use of antibiotics and prognosis. In the other study, we prospectively determined the abundance of specific bacterial genus in patients with HCC by sequencing 16S ribosomal RNA and assessed its association with survival. Subanalysis of the RCT data showed that, of 26 types of antibiotics used, administration of carbapenem before or during chemotherapy was associated with poor progression‐free survival (PFS) and overall survival (OS) of patients with HCC (carbapenem + vs. −; median PFS, 78 days vs. 154 days, p = 0.0053; median OS, 177 days vs. 475 days, p = 0.0003). Multivariate analysis revealed that antianaerobic drug use is an independent predictor of poor prognosis. In the prospective study, the abundance of Blautia in fecal microbiota correlated positively with both PFS and OS of patients with HCC who underwent chemotherapy. Use of antibiotics targeting anaerobes is associated with a poor prognosis in patients with HCC who have undergone chemotherapy, whereas the intestinal anaerobic bacteria, Blautia is associated with a good prognosis. These findings might indicate the need for caution regarding overuse of broad‐spectrum antibiotics targeting anaerobes in patients with HCC. What's new? Overuse of antibiotic drugs alters the composition of gut microbiota and can have detrimental effects on the host. However, it remains unclear whether antibiotics impair the anti‐cancer effects of cytotoxic drugs in cancer patients. Using data from two independent clinical studies, here the authors reveal that use of antibiotics targeting anaerobes is associated with a poor prognosis in patients with hepatocellular carcinoma (HCC) who have undergone chemotherapy, whereas the intestinal anaerobic bacteria, Blautia is associated with a good prognosis. These findings might indicate the need for caution regarding overuse of broad‐spectrum antibiotics targeting anaerobes in patients with HCC.
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Affiliation(s)
- Noriho Iida
- Department of Gastroenterology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takeshi Terashima
- Department of Gastroenterology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kuniaki Arai
- Department of Gastroenterology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Jun Seishima
- Department of Gastroenterology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Abstract
The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.
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146
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Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A. Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits. Pediatrics 2019; 143:e20182491. [PMID: 30962253 PMCID: PMC6565339 DOI: 10.1542/peds.2018-2491] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office. METHODS In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management. RESULTS There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons). CONCLUSIONS At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.
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Affiliation(s)
- Kristin N Ray
- Department of Pediatrics, School of Medicine, University of Pittsburgh and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Zhuo Shi
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Courtney A Gidengil
- RAND Corporation, Boston, Massachusetts
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Sabrina J Poon
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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147
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Homaira N, Wiles LK, Gardner C, Molloy CJ, Arnolda G, Ting HP, Hibbert PD, Braithwaite J, Jaffe A. Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey. BMJ Qual Saf 2019; 28:817-825. [PMID: 30940731 PMCID: PMC6837255 DOI: 10.1136/bmjqs-2018-009028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/24/2022]
Abstract
Background Bronchiolitis is the most common cause of respiratory hospitalisation in children aged <2 years. Clinical practice guidelines (CPGs) suggest only supportive management of bronchiolitis. However, the availability of CPGs do not guarantee that they are used appropriately and marked variation in the clinical management exists. We conducted an assessment of guideline adherence in the management of bronchiolitis in children at a subnationally representative level including inpatient and ambulatory services in Australia. Methods We searched for national and international CPGs relating to management of bronchiolitis in children and identified 16 recommendations which were formatted into 40 medical record audit indicator questions. A retrospective medical record review assessing compliance with the CPGs was conducted across three types of healthcare setting: hospital inpatient admissions, emergency department (ED) presentations and general practice (GP) consultations in three Australian states for children aged <2 years receiving care in 2012 and 2013. Results Purpose-trained surveyors conducted 13 979 eligible indicator assessments across 796 visits for bronchiolitis at 119 sites. Guideline adherence for management of bronchiolitis was 77.3% (95% CI 72.6 to 81.5) for children attending EDs, 81.6% (95% CI 78.0 to 84.9) for inpatients and 52.3% (95% CI 44.8 to 59.7) for children attending GP consultations. While adherence to some individual indicators was high, overall adherence to documentation of 10 indicators relating to history taking and examination was poorest and estimated at 2.7% (95% CI 1.5 to 4.4). Conclusions The study is the first to assess guideline-adherence in both hospital (ED and inpatient) and GP settings. Our study demonstrated that while the quality of care for bronchiolitis was generally adherent to CPG indicators, specific aspects of management were deficient, especially documentation of history taking.
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Affiliation(s)
- Nusrat Homaira
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Louise K Wiles
- University of South Australia, Adelaide, South Australia, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Claire Gardner
- University of South Australia, Adelaide, South Australia, Australia
| | | | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter Damian Hibbert
- University of South Australia, Adelaide, South Australia, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
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Monroy GL, Won J, Dsouza R, Pande P, Hill MC, Porter RG, Novak MA, Spillman DR, Boppart SA. Automated classification platform for the identification of otitis media using optical coherence tomography. NPJ Digit Med 2019; 2:22. [PMID: 31304369 PMCID: PMC6550205 DOI: 10.1038/s41746-019-0094-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
The diagnosis and treatment of otitis media (OM), a common childhood infection, is a significant burden on the healthcare system. Diagnosis relies on observer experience via otoscopy, although for non-specialists or inexperienced users, accurate diagnosis can be difficult. In past studies, optical coherence tomography (OCT) has been used to quantitatively characterize disease states of OM, although with the involvement of experts to interpret and correlate image-based indicators of infection with clinical information. In this paper, a flexible and comprehensive framework is presented that automatically extracts features from OCT images, classifies data, and presents clinically relevant results in a user-friendly platform suitable for point-of-care and primary care settings. This framework was used to test the discrimination between OCT images of normal controls, ears with biofilms, and ears with biofilms and middle ear fluid (effusion). Predicted future performance of this classification platform returned promising results (90%+ accuracy) in various initial tests. With integration into patient healthcare workflow, users of all levels of medical experience may be able to collect OCT data and accurately identify the presence of middle ear fluid and/or biofilms.
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Affiliation(s)
- Guillermo L Monroy
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Jungeun Won
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Roshan Dsouza
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Paritosh Pande
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Malcolm C Hill
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Ryan G Porter
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Michael A Novak
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Darold R Spillman
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Stephen A Boppart
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA.,3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA.,5Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL USA
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149
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Hayes R, Merritt B, Lewis S, Shields J, Gerlach J, Gress TW, Evans J. Antibiotic Prescriptions for Upper Respiratory Infections in a Pediatric Office Versus an Urgent Care Center. Glob Pediatr Health 2019; 6:2333794X19835632. [PMID: 30906818 PMCID: PMC6421603 DOI: 10.1177/2333794x19835632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 12/14/2018] [Indexed: 12/04/2022] Open
Abstract
It is estimated that as many as 10 million unnecessary antibiotic prescriptions are written each year for children. Children are more likely to receive antibiotics for an upper respiratory infection in an urgent care center compared with the primary care office. However, no study has examined the antibiotic prescribing practices of the same physicians in these settings. This retrospective chart review evaluated pediatricians’ antibiotic prescribing practices for patients with symptoms of an upper respiratory tract infection in the office setting and an urgent care setting. There was no difference in the total antibiotic prescribing rate by pediatricians in their primary care office versus an urgent care setting. Pediatricians who were high antibiotic prescribers in the office setting were also high prescribers in the urgent care. The highest prescribing physicians prescribed the appropriate recommended antibiotics for a particular diagnosis the lowest percentage of the time. Efforts to promote antimicrobial stewardship should be directed toward the individual physician and not toward the location where the patients are being evaluated.
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150
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Inappropriate Antibiotic Prescribing for Acute Bronchitis in Children and Impact on Subsequent Episodes of Care and Treatment. Pediatr Infect Dis J 2019; 38:271-274. [PMID: 29794648 PMCID: PMC7918285 DOI: 10.1097/inf.0000000000002117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND To examine whether inappropriate antibiotic treatment for an initial bout of acute bronchitis in childhood affects patterns of future healthcare utilization and antibiotic prescribing. METHODS We conducted a retrospective analysis of children with at least 1 acute bronchitis episode, defined as the 14-day period after an acute bronchitis visit, born in 2008 and followed through 2015 in a nationally representative commercial claims database. We predicted the likelihood of returning for a subsequent acute bronchitis episode, and being prescribed an antibiotic as part of that episode, as a function of whether or not the child was prescribed an antibiotic as part of the first acute bronchitis episode controlling for patient, provider and practice characteristics. RESULTS Children prescribed an antibiotic as part of their initial acute bronchitis episode were more likely both to have a subsequent acute bronchitis episode (hazard ratio = 1.23; 95% confidence interval: 1.17-1.30) and to be prescribed an antibiotic as part of that second episode (hazard ratio = 2.13; 95% confidence interval: 1.99-2.28) compared with children who were not prescribed as part of their first episode. Children diagnosed with asthma were more likely to experience a second visit for acute bronchitis, but less likely to receive an antibiotic as part of that second episode. CONCLUSIONS Inappropriate antibiotic prescribing for a child's initial acute bronchitis episode of care predicted likelihood of subsequent acute bronchitis episodes and antibiotic prescriptions. Providers should consider the downstream effect of inappropriate antibiotic prescribing for acute bronchitis in childhood.
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