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Poole NM, Shapiro DJ, Fleming-Dutra KE, Hicks LA, Hersh AL, Kronman MP. Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014. Pediatrics 2019; 143:peds.2018-1056. [PMID: 30622156 PMCID: PMC6581044 DOI: 10.1542/peds.2018-1056] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 01/21/2023] Open
Abstract
UNLABELLED : media-1vid110.1542/5972296744001PEDS-VA_2018-1056Video Abstract OBJECTIVES: To characterize and compare ambulatory antibiotic prescribing for children in US pediatric and nonpediatric emergency departments (EDs). METHODS A cross-sectional retrospective study of patients aged 0 to 17 years discharged from EDs in the United States was conducted by using the 2009-2014 National Hospital Ambulatory Medical Care Survey ED data. We estimated the proportion of ED visits resulting in antibiotic prescriptions, stratified by antibiotic spectrum, class, diagnosis, and ED type ("pediatric" defined as >75% of visits by patients aged 0-17 years, versus "nonpediatric"). Multivariable logistic regression was used to determine factors independently associated with first-line, guideline-concordant prescribing for acute otitis media, pharyngitis, and sinusitis. RESULTS In 2009-2014, of the 29 million mean annual ED visits by children, 14% (95% confidence interval [CI]: 10%-20%) occurred at pediatric EDs. Antibiotics overall were prescribed more frequently in nonpediatric than pediatric ED visits (24% vs 20%, P < .01). Antibiotic prescribing frequencies were stable over time. Of all antibiotics prescribed, 44% (95% CI: 42%-45%) were broad spectrum, and 32% (95% CI: 30%-34%, 2.1 million per year) were generally not indicated. Compared with pediatric EDs, nonpediatric EDs had a higher frequency of prescribing macrolides (18% vs 8%, P < .0001) and a lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77% vs 87%, P < .001). CONCLUSIONS Children are prescribed almost 7 million antibiotic prescriptions in EDs annually, primarily in nonpediatric EDs. Pediatric antibiotic stewardship efforts should expand to nonpediatric EDs nationwide, particularly regarding avoidance of antibiotic prescribing for conditions for which antibiotics are not indicated, reducing macrolide prescriptions, and increasing first-line, guideline-concordant prescribing.
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Affiliation(s)
- Nicole M. Poole
- Pediatric Infectious Diseases, University of Washington,
Seattle, WA
| | | | | | - Lauri A. Hicks
- Division of Healthcare Quality Promotion, Centers for
Disease Control and Prevention, Atlanta, GA
| | - Adam L. Hersh
- Pediatric Infectious Diseases, University of Utah, Salt
Lake City, UT
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152
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Hum SW, Golder S, Shaikh N. Inadequate harms reporting in randomized control trials of antibiotics for pediatric acute otitis media: a systematic review. Drug Saf 2019; 41:933-938. [PMID: 29737504 DOI: 10.1007/s40264-018-0680-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Reporting of harms in randomized control trials is often inconsistent and inadequate. OBJECTIVE To assess the quality of harms reporting in randomized control trials evaluating the efficacy of antibiotics used to treat pediatric acute otitis media and to investigate whether connections to pharmaceutical companies or the publication of the CONSORT-Harms extension influenced the quality of harms reporting. STUDY DESIGN AND SETTING We considered randomized control trials that evaluated the efficacy and safety of antibiotic treatment for uncomplicated acute otitis media in children aged 0-19. We evaluated the quality of harms reporting using a 19-item checklist addressing the recommendations endorsed in the CONSORT-Harms extension. RESULTS 160 studies met our inclusion criteria. Overall quality of reporting relating to harms was low; on average studies adhered to 55.2% of the checklist items on the quality of harms reporting. The reporting of methods relating the measurement of harms was particularly lacking; studies adhered to an average of only 33.2% of the checklist items. The overall quality of reporting did not change after the publication of the CONSORT-Harms extension. The overall quality of reporting did not differ significantly in reports with or without declared connections to pharmaceutical companies (mean quality score of 56.8% vs 52.0%, respectively). CONCLUSIONS Harms reporting in pediatric randomized trials, especially the reporting of methods used to collect harms data, remains inadequate.
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Affiliation(s)
- Stephanie W Hum
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Su Golder
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Nader Shaikh
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
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153
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Chua KP, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ 2019; 364:k5092. [PMID: 30651273 PMCID: PMC6334180 DOI: 10.1136/bmj.k5092] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the appropriateness of outpatient antibiotic prescribing for privately insured children and non-elderly adults in the US using a comprehensive classification scheme of diagnosis codes in ICD-10-CM (international classification of diseases-clinical modification, 10th revision), which replaced ICD-9-CM in the US on 1 October 2015. DESIGN Cross sectional study. SETTING MarketScan Commercial Claims and Encounters database, 2016. PARTICIPANTS 19.2 million enrollees aged 0-64 years. MAIN OUTCOME MEASURES A classification scheme was developed that determined whether each of the 91 738 ICD-10-CM diagnosis codes "always," "sometimes," or "never" justified antibiotics. For each antibiotic prescription fill, this scheme was used to classify all diagnosis codes in claims during a look back period that began three days before antibiotic prescription fills and ended on the day fills occurred. The main outcome was the proportion of fills in each of four mutually exclusive categories: "appropriate" (associated with at least one "always" code during the look back period, "potentially appropriate" (associated with at least one "sometimes" but no "always" codes), "inappropriate" (associated only with "never" codes), and "not associated with a recent diagnosis code" (no codes during the look back period). RESULTS The cohort (n=19 203 264) comprised 14 571 944 (75.9%) adult and 9 935 791 (51.7%) female enrollees. Among 15 455 834 outpatient antibiotic prescription fills by the cohort, the most common antibiotics were azithromycin (2 931 242, 19.0%), amoxicillin (2 818 939, 18.2%), and amoxicillin-clavulanate (1 784 921, 11.6%). Among these 15 455 834 fills, 1 973 873 (12.8%) were appropriate, 5 487 003 (35.5%) were potentially appropriate, 3 592 183 (23.2%) were inappropriate, and 4 402 775 (28.5%) were not associated with a recent diagnosis code. Among the 3 592 183 inappropriate fills, 2 541 125 (70.7%) were written in office based settings, 222 804 (6.2%) in urgent care centers, and 168 396 (4.7%) in emergency departments. In 2016, 2 697 918 (14.1%) of the 19 203 264 enrollees filled at least one inappropriate antibiotic prescription, including 490 475 out of 4 631 320 children (10.6%) and 2 207 173 out of 14 571 944 adults (15.2%). CONCLUSIONS Among all outpatient antibiotic prescription fills by 19 203 264 privately insured US children and non-elderly adults in 2016, 23.2% were inappropriate, 35.5% were potentially appropriate, and 28.5% were not associated with a recent diagnosis code. Approximately 1 in 7 enrollees filled at least one inappropriate antibiotic prescription in 2016. The classification scheme could facilitate future efforts to comprehensively measure outpatient antibiotic appropriateness in the US, and it could be adapted for use in other countries that use ICD-10 codes.
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Affiliation(s)
- Kao-Ping Chua
- Department of Pediatrics, Child Health Evaluation and Research Center, University of Michigan Medical School, 300 N Ingalls Street, SPC 5456 Room 6E18, Ann Arbor, MI 48109-5456, USA
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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154
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Dawson-Hahn EE, Rhee KE. The association between antibiotics in the first year of life and child growth trajectory. BMC Pediatr 2019; 19:23. [PMID: 30651086 PMCID: PMC6335775 DOI: 10.1186/s12887-018-1363-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/04/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Antibiotics are frequently prescribed to children, and may be an environmental influence that contributes to the increasing prevalence of childhood obesity. The aim of this study was to examine the effect of antibiotic use in the first year of life on child growth trajectories from birth to age 6 years including significant covariates. METHODS Data from 586 children in the Infant Feeding Practices II (IFPS II) and 6 year follow-up study (6YFU) were included. Antibiotic exposures, weight and height measurements were collected from birth through the first 12 months, and then again at 6 years. Linear mixed effects growth modeling, controlling for exclusive breastfeeding, socio-demographic factors, smoking during pregnancy, gestational diabetes, and maternal pre-pregnancy weight status, was used to examine the association between antibiotic exposure and child growth trajectories through age 6 years. RESULTS The majority of infants (60.58%) did not receive any antibiotics; 33.79% received 1-2 courses and 5.63% received 3 or more antibiotic courses during the first year. In the unadjusted model, children with 1-2 antibiotic exposures had a 0.17 (SE 0.08) higher rate of change in BMI z-score (BMIz) than children without any antibiotics, and children with ≥3 exposures had a 0.42 (SE 0.16) higher rate of change in BMIz (p = 0.009). Growth trajectory over time for those who had ≥3 antibiotics was greater than those without any antibiotics (p = 0.002). CONCLUSIONS Efforts to guide the judicious use of antibiotics should continue, particularly in the first year of life.
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Affiliation(s)
- Elizabeth E. Dawson-Hahn
- Department of Pediatrics, University of Washington, Seattle, WA USA
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, M/S CW8-6, PO Box 5371, Seattle, WA 98145 USA
| | - Kyung E. Rhee
- Department of Pediatrics, UCSD School of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, San Diego, CA 92093 USA
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155
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Finkelstein JA, Raebel MA, Nordin JD, Lakoma M, Young JG. Trends in Outpatient Antibiotic Use in 3 Health Plans. Pediatrics 2019; 143:e20181259. [PMID: 30559122 PMCID: PMC6317571 DOI: 10.1542/peds.2018-1259] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Previous analyses of data from 3 large health plans suggested that the substantial downward trend in antibiotic use among children appeared to have attenuated by 2010. Now, data through 2014 from these same plans allow us to assess whether antibiotic use has declined further or remained stable. METHODS Population-based antibiotic-dispensing rates were calculated from the same health plans for each study year between 2000 and 2014. For each health plan and age group, we fit Poisson regression models allowing 2 inflection points. We calculated the change in dispensing rates (and 95% confidence intervals) in the periods before the first inflection point, between the first and second inflection points, and after the second inflection point. We also examined whether the relative contribution to overall dispensing rates of common diagnoses for which antibiotics were prescribed changed over the study period. RESULTS We observed dramatic decreases in antibiotic dispensing over the 14 study years. Despite previous evidence of a plateau in rates, there were substantial additional decreases between 2010 and 2014. Whereas antibiotic use rates decreased overall, the fraction of prescribing associated with individual diagnoses was relatively stable. Prescribing for diagnoses for which antibiotics are clearly not indicated appears to have decreased. CONCLUSIONS These data revealed another period of marked decline from 2010 to 2014 after a relative plateau for several years for most age groups. Efforts to decrease unnecessary prescribing continue to have an impact on antibiotic use in ambulatory practice.
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Affiliation(s)
- Jonathan A Finkelstein
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Marsha A Raebel
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado; and
| | | | - Matthew Lakoma
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jessica G Young
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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156
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King LM, Bartoces M, Hersh AL, Hicks LA, Fleming-Dutra KE. National Incidence of Pediatric Mastoiditis in the United States, 2000-2012: Creating a Baseline for Public Health Surveillance. Pediatr Infect Dis J 2019; 38:e14-e16. [PMID: 29601460 PMCID: PMC6541217 DOI: 10.1097/inf.0000000000002049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Between 2000 and 2012, the national estimated incidence rate of pediatric mastoiditis, a rare but serious complication of acute otitis media, was highest in 2006 (2.7/100,000 population) and lowest in 2012 (1.8/100,000 population). This measure provides a baseline for public health surveillance in the pneumococcal conjugate vaccine era as stewardship efforts target antibiotic use in acute otitis media.
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Affiliation(s)
- Laura M. King
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monina Bartoces
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam L. Hersh
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, UT, USA
| | - Lauri A. Hicks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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157
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Al-Sayyed B, Le J, Al-Tabbaa MM, Barnacle B, Ren J, Tapping R, Aiyer M. Uncomplicated Urinary Tract Infection in Ambulatory Primary Care Pediatrics: Are We Using Antibiotics Appropriately? J Pediatr Pharmacol Ther 2019; 24:39-44. [PMID: 30837813 DOI: 10.5863/1551-6776-24.1.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Antimicrobial stewardship programs target antimicrobial use within the inpatient care setting. However, most antimicrobials are prescribed at ambulatory sites. We aim to determine the appropriateness of the diagnosis and treatment of uncomplicated urinary tract infection (UTI) in children within the outpatient setting at our institution, and to evaluate the cost of antibiotic treatment in our patient cohort. METHODS This retrospective study was conducted by reviewing electronic records of patients aged 2 to 18 years diagnosed with uncomplicated UTI and treated with antibiotics in the outpatient setting from January 1, 2016, to April 30, 2016. Appropriate diagnosis was defined as confirmed UTI that included: pyuria (>5 white blood cells per high-power field or positive for leukocyte esterase), a positive urine culture (≥50,000 colony units/mL of a single uropathogen for a catheterized sample or ≥100,000 colony units/mL for a clean catch urine sample), and lower urinary tract symptoms. Treatment was considered appropriate if the patient was prescribed first-line antibiotic for the susceptible isolate (trimethoprim sulfamethoxazole, amoxicillinclavulanate, nitrofurantoin, and cephalexin), and if the appropriate dose was used. RESULTS We included 178 patients receiving a diagnosis of uncomplicated UTI and treated with antibiotics. Of these, 70% received an inappropriate diagnosis (n = 125). 58% (n= 72) of improperly diagnosed patients had polymicrobial growth in their urine cultures. Antibiotics prescribed mostly in this group were trimethoprim-sulfamethoxazole (53%, n = 66) and cephalexin (22%, n = 27). Only 30% of all included patients received an appropriate diagnosis (n = 53). Of all appropriate diagnosis patients (n = 53), 26% were treated inappropriately (n = 14) with either wide-spectrum antibiotics (n = 8) or with low calculated dose (n = 6). The estimated cost of antibiotic treatment for the inappropriate diagnosis group (n = 125) was $10,755.87. CONCLUSION Antimicrobial stewardship programs should target the pediatric outpatient setting and antibiograms should be developed. Education of providers about the appropriate diagnosis and treatment of uncomplicated UTI in children is essential for reducing the cost of inappropriate therapy.
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158
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Wensaas KA, Heron J, Redmond N, Turnbull S, Christensen H, Thornton H, Peters TJ, Blair PS, Hay AD. Post-consultation illness trajectories in children with acute cough and respiratory tract infection: prospective cohort study. Fam Pract 2018; 35:676-683. [PMID: 29897430 PMCID: PMC6290772 DOI: 10.1093/fampra/cmy021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about respiratory tract infection (RTI) severity in children following consultation. OBJECTIVES To investigate post-consultation symptom trajectories in children with acute cough and RTI and whether baseline characteristics predict trajectory group. METHODS Prospective cohort study of 2296 children (3 months-16 years) whose parents were invited to report cough severity and duration using a 7-point Likert scale. Longitudinal latent class analysis (LLCA) was used to identify post-consultation symptom trajectories in the first 15 days, and multinomial models to predict class membership. RESULTS Complete data were available for 1408 children (61%). The best LLCA model identified five post-consultation symptom trajectory groups: 'very rapid recovery' (28.5%), 'rapid recovery' (37.7%), 'intermediate recovery' (18.2%), 'persistent symptoms' (9.5%) and 'initial deterioration with persistent symptoms' (6.0%). Compared with very rapid recovery, parent-reported severe cough in the 24 hours prior to consultation increased the likelihood of rapid recovery (OR 1.79 [95% CI 1.23, 2.60]), intermediate recovery (OR 2.13 [1.38, 3.30] and initial deterioration with persistent symptoms (OR 2.29 [1.26, 4.16]). Initial deterioration was also associated with 'severe barking cough' (OR 3.64 [1.50, 8.82]), 'severely reduced energy in the 24 hours prior to consultation' (OR 3.80 [1.62, 8.87] and higher parent-assessed illness severity at consultation (OR 2.21 [1.17, 4.18]). CONCLUSION We identified five distinct symptom trajectory groups showing the majority of children improved post-consultation, with only one group experiencing illness deterioration. The few characteristics associated with group membership did not fall into a pattern that seemed clinically useful.
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Affiliation(s)
- Knut-Arne Wensaas
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Niamh Redmond
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sophie Turnbull
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Christensen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Thornton
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter S Blair
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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159
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Szymczak JE, Klieger SB, Miller M, Fiks AG, Gerber JS. What Parents Think About the Risks and Benefits of Antibiotics for Their Child's Acute Respiratory Tract Infection. J Pediatric Infect Dis Soc 2018; 7:303-309. [PMID: 28992328 DOI: 10.1093/jpids/pix073] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/09/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Parental pressure is often cited as a reason for why pediatricians overuse antibiotics for children with acute respiratory tract infection (ARTI). We sought to capture parent perceptions of antibiotics at the time of their child's presentation with an ARTI. METHODS We conducted semistructured interviews with parents of children who presented with ARTI symptoms to 1 of 4 diverse practices in a large hospital-affiliated network of pediatric primary care practices. Parents were interviewed before their child was seen by the pediatrician and asked about their perceptions of antibiotics. RESULTS Interviews were conducted with 109 parents. None of the parents said they planned to ask the pediatrician for antibiotics but instead expected to gain reassurance and a plan to minimize symptoms. Three perceptions about antibiotics were identified: parents have a sense of wariness when their child is prescribed antibiotics, they have an understanding that antibiotic overuse is a problem but that it is driven by the demands of other parents, and they have a preference for alternative treatment. The majority of the parents were not concerned about antibiotic resistance. In response to closed-ended questions designed to assess their level of concern with adverse effects, parents were most concerned with their child developing an upset stomach, having an allergic reaction, and experiencing diarrhea. The parents were not concerned with antibiotic treatment failure. CONCLUSIONS Parents in our study expressed a sense of caution about antibiotics and an awareness that they should be used judiciously. Our findings indicate that parents are aware of the downsides of antibiotics and might be willing to partner with healthcare providers to improve appropriate use.
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Affiliation(s)
- Julia E Szymczak
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sarah B Klieger
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania
| | - Matthew Miller
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania.,Department of General Pediatrics, Children's Hospital of Philadelphia, Pennsylvania
| | - Jeffrey S Gerber
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
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160
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Frost HM, McLean HQ, Chow BDW. Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty. J Pediatr 2018; 203:76-85.e8. [PMID: 30195553 DOI: 10.1016/j.jpeds.2018.07.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/11/2018] [Accepted: 07/11/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate variation in antibiotic prescribing between pediatric and nonpediatric providers for common upper respiratory illnesses. STUDY DESIGN Patient encounters for children aged <18 years from a regional health care system were identified. Electronic medical records from 2011 to 2016 were extracted for diagnoses of upper respiratory infection, pharyngitis, acute otitis media, and sinusitis. Encounters with competing medical diagnoses, recent hospitalization, and antibiotic prescriptions within 30 days were excluded. Adherence to antibiotic guidelines was assessed by provider training (pediatric, nonpediatric physicians, and advance practice providers). Additional factors assessed were calendar year, and patient's age, sex, insurance status, and number of sick visits in the prior year. RESULTS Across 6 years, 141 361 visits were examined: 43 914 for upper respiratory infection, 43 701 for pharyngitis, 43 925 for acute otitis media, and 9821 for sinusitis. Pediatricians were more likely than Advanced practice providers (APP) and nonpediatric providers to have guideline-concordant prescribing for pharyngitis (pediatricians, 66.7% [95% CI, 54.5-77.0]; nonpediatricians, 49.1% [95% CI, 36.3-62.0], APPs, 52.2% [95% CI, 39.4-64.7]; P < .0001) and sinusitis (pediatricians, 70.8% [95% CI, 53.8-83.4], nonpediatricians, 63.3% [95% CI, 46.8-77.2], APPs, 62.1% [95% CI, 45.1-76.5]; P = .48) and to withhold antibiotics for upper respiratory infection than APPs and nonpediatric providers (pediatricians, 86.6% [95% CI, 81.2-90.6], nonpediatricians, 80.8% [95% CI, 73.0-86.8], APPs, 76.8% [95% CI, 68.4-83.5]; P < .0001). Pediatricians were less likely to prescribe antibiotics for pharyngitis without a positive test for group A Streptococcus than APPs and nonpediatric providers (pediatricians, 15.1% [95% CI, 10.4-21.6], nonpediatricians, 29.4% [95% CI, 20.8-39.6], APPs, 27.2% [95% CI, 19.3-36.9]; P < .0001). First-line antibiotic prescribing for acute otitis media did not differ between provider specialties. A trend toward more guideline-concordant prescribing was seen for pharyngitis and sinusitis over the study period. CONCLUSIONS Pediatricians were more likely to adhere to guidelines for management of pediatric acute respiratory infections. Pediatric antibiotic stewardship efforts should also target nonpediatricians.
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Affiliation(s)
- Holly M Frost
- University of Colorado, Department of Pediatrics, Aurora, CO; Denver Health and Hospital Authority, Department of Pediatrics, Denver, CO; Marshfield Clinic Research Institute, Marshfield, WI.
| | | | - Brian D W Chow
- Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA; Tufts University School of Medicine, Boston, MA
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161
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Adisa R, Orherhe OM, Fakeye TO. Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria. Afr Health Sci 2018; 18:1189-1201. [PMID: 30766585 PMCID: PMC6354862 DOI: 10.4314/ahs.v18i4.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Irrational antibiotic prescriptions for children is a global concern requiring periodic evaluation and monitoring. Objectives To assess appropriateness of antibiotic prescribing for under-five children, as well as evaluating mothers' usage of antibiotics for their under-five and reason(s) for use. Method Cross-sectional review of out-patient case-notes of under-five using principles of antibiotic prescribing and a questionnaire-guided interaction with under-five mothers. Results Nearly all (445;98.9%) antibiotic prescriptions were based on signs and symptoms indicative of bacterial infection. Only 3(0.7%) had the initial antibiotic regimen modified. Nine (2.0%) had documented evidence of sensitivity test requested before antibiotic prescribing. Presence of infection or need for antibiotic therapy was established in 190(42.2%). Majority (324;72.0%) of mothers had administered antibiotics to their under-five. Of these, 157(48.5%) were prescribed by physicians and 79(24.4%) were self-recommended. Educational status of mothers significantly influenced antibiotic usage. Conclusion Antibiotic prescriptions for under-fives was largely based on symptoms indicative of bacterial infections, thereby corroborating the widespread empirical antibiotic prescribing. Considerable number of mothers engaged in self-recommendation of antibiotics for their under-fives. Thus, there is a need for continuous enlightenment of prescribers and mothers on rational use of antibiotics, while microbiological confirmation of clinical diagnosis is encouraged for evidence-based antibiotic prescribing.
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Affiliation(s)
- Rasaq Adisa
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Ochuko M Orherhe
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Titilayo O Fakeye
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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162
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Variation in Outpatient Antibiotic Dispensing for Respiratory Infections in Children by Clinician Specialty and Treatment Setting. Pediatr Infect Dis J 2018; 37:1248-1254. [PMID: 30408006 DOI: 10.1097/inf.0000000000002004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Antibiotics are commonly prescribed for children with acute respiratory infections (ARIs). This study describes the distribution of ARI diagnoses and specifically quantifies antibiotic dispensing for bronchitis and upper respiratory infection (URI) by treatment setting and specialty. METHODS This retrospective, observational cross-sectional study used data from the HealthCore Integrated Research Environment containing claims from 14 commercial health plans for 2012 to 2014. Children (2-17 years) with first-episode ARI were identified by diagnosis of acute otitis media (AOM), sinusitis, pharyngitis, bronchitis or URI with no competing infections or chronic illnesses. Treatment setting was where diagnoses were made: primary care offices, urgent care centers (UCC), retail health clinics (RHCs) or emergency departments. Primary outcome measure was antibiotic prescription fills from pharmacies within 2 days of start of ARI episode. RESULTS For URI, the highest proportions in antibiotic dispensing were ordered by office-based or UCC family physicians (28% and 30%, respectively) and office-based or UCC nurse practitioners/physician assistants (30% and 29%, respectively). Across all settings and specialties, there was high proportion of antibiotic dispensing for bronchitis (75%). Overall, 48% of 544,531 children diagnosed with ARI filled antibiotics. Nurse practitioners/physician assistants in RHC made the most diagnoses of AOM (24%) and streptococcal pharyngitis (22%). CONCLUSIONS Outreach efforts to decrease antibiotic dispensing for URI can be focused on office-based and UCC family physicians and nurse practitioners/physician assistants. All specialties need widespread interventions to reduce antibiotic dispensing for bronchitis. RHC nurse practitioners/physician assistants can be targeted to reduce high proportion of AOM and streptococcal pharyngitis diagnoses.
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163
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Smith RA, MacGeorge EL, Hackman NM, M'ikanatha NM. Campaign Preparation for Complex Initiatives: A Person-Centered Approach to Audience Segmentation of Parents' Antibiotic Stewardship. HEALTH COMMUNICATION 2018; 33:1539-1548. [PMID: 29068705 PMCID: PMC6085158 DOI: 10.1080/10410236.2017.1384345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The evolution of antibiotic resistance is outpacing the speed at which new antibiotics will reach the marketplace. To slow the rate of resistance, people need to engage in antibiotic stewardship, which includes acts to prevent the spread of bacteria and judicious use of antibiotics to treat infections. This study identified the patterns and predictors of antibiotic stewardship behaviors of parents (N = 516) related to their children. The latent class analysis revealed three profiles of parental stewardship, labeled Stewards, Requesters, and Non-Stewards. The findings implied different campaign goals: to encourage Stewards to follow through on their intentions, to encourage Requesters to stop asking providers for antibiotics when their children have ear infections, and to influence Non-Stewards to accept medical advice when an antibiotic is not indicated and to dispose of leftover antibiotics. The covariate analysis provided theoretical insight into the strategies to pursue in campaigns targeting these three groups. For example, parents who perceived antibiotic-resistant infections as less serious health conditions, felt less worry when thinking about their child getting an antibiotic-resistant infection, and had stronger misattributions of antibiotics' efficacy to treat multiple symptoms were more likely to be Requesters and Non-Stewards, instead of Stewards.
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Affiliation(s)
- Rachel A Smith
- a Department of Communication Arts & Sciences , The Pennsylvania State University
| | - Erina L MacGeorge
- a Department of Communication Arts & Sciences , The Pennsylvania State University
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164
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Yang YH, Buttery J. Antimicrobial resistance: a global one-health problem for all ages. World J Pediatr 2018; 14:521-522. [PMID: 30298235 DOI: 10.1007/s12519-018-0194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yong-Hong Yang
- Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
- Shenzhen Children's Hospital, Shenzhen, China
| | - Jim Buttery
- Department of Infection and Immunity, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
- Monash University, Melbourne, VIC, Australia.
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165
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Wei S, Mortensen MS, Stokholm J, Brejnrod AD, Thorsen J, Rasmussen MA, Trivedi U, Bisgaard H, Sørensen SJ. Short- and long-term impacts of azithromycin treatment on the gut microbiota in children: A double-blind, randomized, placebo-controlled trial. EBioMedicine 2018; 38:265-272. [PMID: 30478001 PMCID: PMC6306380 DOI: 10.1016/j.ebiom.2018.11.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 01/12/2023] Open
Abstract
Background Macrolides are commonly prescribed for respiratory infections and asthma-like episodes in children. While their clinical benefits have been proved, concerns regarding the side-effects of their therapeutic use have been raised. Here we assess the short- and long-term impacts of azithromycin on the gut microbiota of young children. Methods We performed a randomized, double-blind, placebo-controlled trial in a group of children aged 12–36 months, diagnosed with recurrent asthma-like symptoms from the COPSAC2010 cohort. Each acute asthma-like episode was randomized to a 3-day course of azithromycin oral solution of 10 mg/kg per day or placebo. Azithromycin reduced episode duration by half, which was the primary end-point and reported previously. The assessment of gut microbiota after treatment was the secondary end-point and reported in this study. Fecal samples were collected 14 days after randomization (N = 59, short-term) and again at age 4 years (N = 49, long-term, of whom N = 18 were placebo treated) and investigated by 16S rRNA gene amplicon sequencing. Findings Short-term, azithromycin caused a 23% reduction in observed richness and 13% reduction in Shannon diversity. Microbiota composition was shifted primarily in the Actinobacteria phylum, especially a reduction of abundance in the genus Bifidobacterium. Long-term (13–39 months after treatment), we did not observe any differences between the azithromycin and placebo recipients in their gut microbiota composition. Interpretation Azithromycin treatment induced a perturbation in the gut microbiota 14 days after randomization but did not have long-lasting effects on the gut microbiota composition. However, it should be noted that our analyses included a limited number of fecal samples for the placebo treated group at age 4 years. Fund Lundbeck Foundation, Danish Ministry of Health, Danish Council for Strategic Research, Capital Region Research Foundation, China Scholarship Council.
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Affiliation(s)
- Shaodong Wei
- Department of Biology, Section of Microbiology, University of Copenhagen, Universitetsparken 15, bldg. 1, DK2100, Copenhagen, Denmark
| | - Martin Steen Mortensen
- Department of Biology, Section of Microbiology, University of Copenhagen, Universitetsparken 15, bldg. 1, DK2100, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Ledreborg Alle 34, 2820 Gentofte, Denmark
| | - Asker Daniel Brejnrod
- Department of Biology, Section of Microbiology, University of Copenhagen, Universitetsparken 15, bldg. 1, DK2100, Copenhagen, Denmark
| | - Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Ledreborg Alle 34, 2820 Gentofte, Denmark
| | - Morten Arendt Rasmussen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Ledreborg Alle 34, 2820 Gentofte, Denmark; Section of Chemometrics and Analytical Technologies, Department of Food Science, University of Copenhagen, Rolighedsvej 30, 1958 Frederiksberg C, Denmark
| | - Urvish Trivedi
- Department of Biology, Section of Microbiology, University of Copenhagen, Universitetsparken 15, bldg. 1, DK2100, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Ledreborg Alle 34, 2820 Gentofte, Denmark
| | - Søren Johannes Sørensen
- Department of Biology, Section of Microbiology, University of Copenhagen, Universitetsparken 15, bldg. 1, DK2100, Copenhagen, Denmark.
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166
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Bianco A, Papadopoli R, Mascaro V, Pileggi C, Pavia M. Antibiotic prescriptions to adults with acute respiratory tract infections by Italian general practitioners. Infect Drug Resist 2018; 11:2199-2205. [PMID: 30519057 PMCID: PMC6233949 DOI: 10.2147/idr.s170349] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The overuse, misuse, and underuse of antimicrobial agents often lead to the spread of antibiotic-resistant microorganisms. The aim of our study was to describe the pattern of antibiotic prescriptions for acute respiratory tract infections (RTIs) among the adult population and the factors associated with antibiotic prescribing. Patients and methods The study involved patients who visited a general practitioner with suspected acute RTI. Patients with diagnosis of acute sinusitis, acute pharyngitis, acute bronchitis, and influenza were included in the study. We evaluated the presence of an indication for antibiotic therapy for selected diseases according to international guidelines. The appropriateness of any prescribed molecule was also evaluated. Results A total of 1,979 cases of acute RTIs were included: 1,196 (60.4%) pharyngitis, 359 (18.2%) bronchitis, 234 (11.8%) influenza, and 190 (9.6%) sinusitis. An antibiotic prescription was given in 67.3% of the consultations and was not indicated by the guidelines in 66.5% of the total RTIs. Macrolides were the most frequently prescribed antibiotics accounting for 32.5% of all those prescribed, followed by amoxicillin with clavulanic acid (31.1%) and fluoroquinolones (14.2%). The highest overprescription was associated with pharyngitis (65.9%) and the lowest with influenza (4.9%). A throat swab was performed only in 11 of all the patients with a diagnosis of acute pharyngitis. Conclusion The present study showed a very high frequency of nonevidence-based prescription of antibiotics at the primary care level. Future improvement programs should focus on development of evidence-based guidelines, access to postgraduate training, and better availability of diagnostic tools.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy,
| | - Rosa Papadopoli
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy,
| | - Valentina Mascaro
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy,
| | - Claudia Pileggi
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy,
| | - Maria Pavia
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy,
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Poole NM. Judicious antibiotic prescribing in ambulatory pediatrics: Communication is key. Curr Probl Pediatr Adolesc Health Care 2018; 48:306-317. [PMID: 30389361 DOI: 10.1016/j.cppeds.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Children in outpatient clinics are prescribed over 15 million courses of unnecessary antibiotics annually. Clinicians have identified parent pressure for antibiotics, parent satisfaction, and time constraints as the primary drivers of unnecessary antibiotic prescribing. Over the past decade, parents have become more aware that antibiotics only treat bacterial infections, yet continue to report an expectation for antibiotics in 50-65% of acute care visits. Parental expectations for antibiotics stem from parental concerns about symptom severity and a desire to alleviate symptoms. Clinicians can address parental concerns when they assess the severity of illness through a physical exam, provide a clear explanation for the symptoms, recommend ways to alleviate the symptoms, and provide council on when to be concerned. When clinicians fail to address parental concerns, parents are more likely to challenge the diagnosis or treatment recommendations, clinicians are more likely to perceive that parent as expecting an antibiotic, and antibiotics are significantly more likely to be prescribed. Parents that expect antibiotics are more likely to communicate using a 'candidate diagnosis' (e.g., "Johnny has strep throat.") and resist the diagnosis or treatment given. Clinicians can recognize these parental communication patterns and use specific communication practices shown to decrease unnecessary antibiotic prescribing. When parents expect antibiotics, clinicians should (1) review physical exam findings using 'no problem' commentary (e.g., "This ear is just a little red."), (2) deliver a specific diagnosis (e.g., avoid 'a virus'), (3) use a two-part negative/positive treatment recommendation (e.g., "On the one hand, antibiotics will not help. On the other hand, ibuprofen can help with pain."), and (4) provide a contingency plan. Clinicians should feel comfortable discussing the risks and benefits of antibiotics. Effective communication between parents and clinicians in outpatient clinics leads to more judicious antibiotic prescribing, higher parent satisfaction scores, and more efficient clinic visits.
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Affiliation(s)
- Nicole M Poole
- Seattle Children's Research Institute, Seattle, WA, United States; University of Washington, Seattle, WA, United States; Seattle Children's Hospital, Seattle, WA, United States.
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168
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Yonts AB, Kronman MP, Hamdy RF. The Burden and Impact of Antibiotic Prescribing in Ambulatory Pediatrics. Curr Probl Pediatr Adolesc Health Care 2018; 48:272-288. [PMID: 30337150 DOI: 10.1016/j.cppeds.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Antibiotics are one of the most commonly prescribed classes of medication for children and adolescents. While they are arguably the most powerful tool we possess against bacterial infections, they are frequently given to children whose illnesses are due to viruses or other non-infectious etiologies. When antibiotics are not used judiciously, the consequences can be serious and accumulate over time. This review article quantifies the burden of antimicrobial use in the pediatric outpatient setting in the United States, reviews recommended first line antibiotic regimens for common outpatient pediatric and adolescent conditions, investigates the reasons for inappropriate prescribing of antibiotics in outpatient healthcare settings, and explores the range of consequences of overuse and inappropriate use of antibiotics, from adverse drug reactions to impact on the microbiome to rising rates of antimicrobial resistance in common ambulatory conditions.
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Affiliation(s)
- Alexandra B Yonts
- Division of Infectious Diseases, Children's National Medical Center, Washington, D.C., United States
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Rana F Hamdy
- Division of Infectious Diseases, Children's National Medical Center, Washington, D.C., United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States.
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169
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From paper to practice: Strategies for improving antibiotic stewardship in the pediatric ambulatory setting. Curr Probl Pediatr Adolesc Health Care 2018; 48:289-305. [PMID: 30322711 DOI: 10.1016/j.cppeds.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Antibiotic stewardship aims to better patient outcomes, reduce antibiotic resistance, and decrease unnecessary health care costs by improving appropriate antibiotic use. More than half of annual antibiotic expenditures for antibiotics in the United States are prescribed in the ambulatory setting. This review provides a summary of evidence based strategies shown to improve antibiotic prescribing in ambulatory care settings including: providing education to patients and their families, providing education to clinicians regarding best practices for specific conditions, providing communications training to clinicians, implementing disease-specific treatment algorithms, implementing delayed prescribing for acute otitis media, supplying prescribing feedback to providers with peer comparisons, using commitment letters, and prompting providers to justify antibiotic prescribing for diagnoses for which antibiotics are not typically recommended. These various mechanisms to improve stewardship can be tailored to a specific practice's work flow and culture. Interventions should be used in combination to maximize impact. The intent with this review is to provide an overview of strategies that pediatric providers can take from paper to practice.
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170
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Azor-Martinez E, Yui-Hifume R, Muñoz-Vico FJ, Jimenez-Noguera E, Strizzi JM, Martinez-Martinez I, Garcia-Fernandez L, Seijas-Vazquez ML, Torres-Alegre P, Fernández-Campos MA, Gimenez-Sanchez F. Effectiveness of a Hand Hygiene Program at Child Care Centers: A Cluster Randomized Trial. Pediatrics 2018; 142:peds.2018-1245. [PMID: 30297500 DOI: 10.1542/peds.2018-1245] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Respiratory infections (RIs) are an important cause of morbidity and excessive antibiotic prescriptions in children attending day care centers (DCCs). We aimed to assess the effectiveness of an educational and hand hygiene program in DCCs and homes in reducing RI incidence and antibiotic prescriptions in children. METHODS A cluster, randomized, controlled, and open study of 911 children aged 0 to 3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up. Two intervention groups of DCC families performed educational and hand hygiene measures, 1 with soap and water (SWG; n = 274), another with hand sanitizer (HSG; n = 339), and the control group (CG; n = 298) followed usual hand-washing procedures. RI episode rates were compared through multilevel Poisson regression models. The percentage of days missed were compared with Poisson exact tests. RESULTS There were 5211 RI episodes registered. Children in the HSG had less risk of RI episodes (incidence rate ratio [IRR]: 0.77; 95% confidence interval [CI]: 0.68-0.88) and antibiotic prescriptions (IRR: 0.69; 95% CI: 0.57-0.84) compared with the those in the CG. Children in the SWG had a higher risk of RI episodes (IRR: 1.21; 95% CI: 1.06-1.39) and antibiotic prescriptions (IRR: 1.31; 95% CI: 1.08-1.56) than those in the HSG. Pupils missed 5186 DCC days because of RIs, and the percentage of days absent was significantly lower in the HSG compared with the CG (P < .001) and the SWG (P < .001). CONCLUSIONS Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents, reduce absent days, RIs, and antibiotic prescriptions for these infections in children at DCCs.
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Affiliation(s)
| | | | | | | | | | | | - Llenalia Garcia-Fernandez
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Seplin Soluciones Estadísticas, Granada, Spain; and
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Schot MJC, Dekker ARJ, Giorgi WG, Hopstaken RM, de Wit NJ, Verheij TJM, Cals JWL. Diagnostic value of signs, symptoms and diagnostic tests for diagnosing pneumonia in ambulant children in developed countries: a systematic review. NPJ Prim Care Respir Med 2018; 28:40. [PMID: 30367067 PMCID: PMC6203790 DOI: 10.1038/s41533-018-0104-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/03/2018] [Accepted: 08/23/2018] [Indexed: 11/13/2022] Open
Abstract
Identifying a child with pneumonia in the large group of children with acute respiratory tract infections can be challenging for primary care physicians. Knowledge on the diagnostic value of specific signs and symptoms may guide future decision rules and guidelines for clinicians. We aimed to identify and systematically review available evidence for the diagnostic value of signs, symptoms, and additional tests to diagnose pneumonia in children in an ambulatory setting in developed countries. We conducted a systematic review, searching in the electronic databases of PubMed and Embase. Quality assessment of studies was done using the QUADAS-2 criteria. After data extraction from selected studies, we calculated and summarized test characteristics (sensitivity, specificity, negative and positive predictive values) of all available signs, symptoms, additional laboratory tests, and chest ultrasonography. The original search yielded 4665 records, of which 17 articles were eligible for analysis: 12 studies on signs and symptoms, 4 on additional laboratory tests, and 6 on ultrasonography. All included studies were performed in a secondary care setting. Risk of bias was present in the majority of studies in the domain of patient selection. Prevalence of pneumonia varied from 3.4% to 71.7%. The diagnostic value of the available 27 individual signs and symptoms to identify pneumonia was low. In a low prevalence setting, (4 studies, pneumonia prevalence <10%) clinically ill appearance of the child and oxygen saturation <94% can aid a physician. In a high prevalence setting (10 studies, pneumonia >10%), additional diagnostic tests such as oxygen saturation, C-reactive protein, and white blood cell count are more promising. Chest ultrasonography showed high diagnostic value in settings with higher prevalence of pneumonia. Single signs and symptoms from medical history and physical examination or individual additional diagnostic tests are insufficient to diagnose pneumonia in ambulant children. Very few diagnostic studies are conducted in settings with low prevalence of pneumonia. Future research in low prevalence settings should focus on the diagnostic value of the combination of clinical features and additional testing possibly using meta-analysis of individual data.
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Affiliation(s)
- Marjolein J C Schot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Anne R J Dekker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wesley G Giorgi
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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172
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Baek YH, Shin JY. Trends in polypharmacy over 12 years and changes in its social gradients in South Korea. PLoS One 2018; 13:e0204018. [PMID: 30226885 PMCID: PMC6143262 DOI: 10.1371/journal.pone.0204018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/01/2018] [Indexed: 12/16/2022] Open
Abstract
Polypharmacy is associated with adverse drug reactions and represents an economic burden on the health insurance system. The objective of our study was to assess the trends in polypharmacy and its associated factors in South Korea. This cross-sectional study used a nationwide sampled database between 2002 and 2013, including outpatients of all ages who received at least 1 prescription in the same period. Polypharmacy was defined as the concomitant prescription of ≥6 distinct medications on a single prescription at least once without a given duration. The yearly prescribing trends were calculated and plotted. We conducted comparative analyses to identify the changes in social gradients of polypharmacy between the first 2 years, 2002‒2003, and the final 2 years, 2012‒2013. We repeated logistic regressions for pediatrics <20 years of age and adults ≥20 years of age to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI). The distributions of polypharmacy in the respective periods were examined according to patient economic status (0 = most deprived and 10 = most affluent). The age-standardized prevalence of polypharmacy decreased from 65.8% in 2002 to 43.7% in 2013. Our study included 1,108,298 outpatients throughout 2002–2013. Pediatric patients aged 1–9 years had the highest number of medications among all age groups (mean: 5.1 ± 1.1 in 2002–2003 vs. 4.1 ± 1.1 in 2012–2013) in both periods. Changes in the association between deprivation and polypharmacy over 10 years were observed in adults (aOR = 0.68; 95% CI = 0.62–0.75 in 2002–2003 vs. 1.60; 95% CI = 1.54–1.66 in 2012–2013) and pediatrics (aOR = 0.60; 95% CI = 0.52–0.68 in 2002–2003 vs. 1.07; 95% CI = 1.01–1.14 in 2012–2013) compared with those in the most affluent patients. The high level of polypharmacy in pediatric patients is a public health concern that warrants policymaker attention.
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Affiliation(s)
- Yeon-Hee Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- * E-mail:
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Echavarría M, Marcone DN, Querci M, Seoane A, Ypas M, Videla C, O'Farrell C, Vidaurreta S, Ekstrom J, Carballal G. Clinical impact of rapid molecular detection of respiratory pathogens in patients with acute respiratory infection. J Clin Virol 2018; 108:90-95. [PMID: 30267999 PMCID: PMC7172208 DOI: 10.1016/j.jcv.2018.09.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022]
Abstract
Diagnosis with FilmArray-RP was associated with changes in medical management. Accurate and rapid diagnosis decreased antibiotic use and complementary studies, and improved oseltamivir use. The multiplex PCR respiratory panel permitted a high viral detection rate not only in children but in adults.
Background Acute respiratory infections (ARI) are a leading cause of morbidity and mortality worldwide. There is a need to demonstrate the clinical impact of using the new, rapid and sensitive molecular assays in prospectively designed studies. Objectives To study the impact on medical management of a rapid molecular assay in patients with respiratory infections. Study design A prospective, randomized, non-blinded study was performed in patients presenting to the Emergency Department during two respiratory seasons (2016–2017). Diagnosis was performed by FilmArray Respiratory Panel (FilmArray-RP) or by immunofluorescence assay (IFA). Results A total of 432 patients (156 children and 276 adults) were analyzed. Diagnosis with FilmArray-RP was associated with significant changes in medical management including withholding antibiotic prescriptions (OR:15.52, 95%CI:1.99–120.83 in adults and OR:12.23, 95%CI:1.56–96.09 in children), and reduction in complementary studies in children (OR:9.64, 95%CI:2.13–43.63) compared to IFA. Decrease in oseltamivir prescriptions was significantly higher in adults in the FilmArray-RP group (p = 0.042; OR:1.19, 95%CI:0.51-2.79) compared to adults managed with IFA. Diagnostic yield was significantly higher by FilmArray-RP (81%) than by IFA (31%)(p < 0.001). The median time from sample collection to reporting was 1 h 52 min by FilmArray-RP and 26 h by IFA (p < 0.001). Conclusions The high respiratory viruses’ detection rate and availability of results within two hours when using FilmArray-RP were associated with decreases in antibiotic prescriptions and complementary studies and more accurate use of oseltamivir.
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Affiliation(s)
- M Echavarría
- Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas "CEMIC" - Consejo Nacional de Investigaciones Científicas y Técnicas "CONICET", Av. Galván 4102 (1431), Buenos Aires City, Argentina; Virology Laboratory, Centro de Educación Médica e Investigaciones Clínicas "CEMIC" - Consejo Nacional de Investigaciones Científicas y Técnicas "CONICET", Av. Galván 4102 (1431), Buenos Aires City, Argentina.
| | - D N Marcone
- Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas "CEMIC" - Consejo Nacional de Investigaciones Científicas y Técnicas "CONICET", Av. Galván 4102 (1431), Buenos Aires City, Argentina
| | - M Querci
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas "CEMIC", Av. Galván 4102 (1431), Buenos Aires City, Argentina
| | - A Seoane
- Emergency Department, Centro de Educación Médica e Investigaciones Clínicas "CEMIC", Av. Galván 4102 (1431), Buenos Aires City, Argentina
| | - M Ypas
- Emergency Department, Centro de Educación Médica e Investigaciones Clínicas "CEMIC", Av. Galván 4102 (1431), Buenos Aires City, Argentina
| | - C Videla
- Virology Laboratory, Centro de Educación Médica e Investigaciones Clínicas "CEMIC" - Consejo Nacional de Investigaciones Científicas y Técnicas "CONICET", Av. Galván 4102 (1431), Buenos Aires City, Argentina
| | - C O'Farrell
- Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas "CEMIC" - Consejo Nacional de Investigaciones Científicas y Técnicas "CONICET", Av. Galván 4102 (1431), Buenos Aires City, Argentina; Instituto Universitario CEMIC, Centro de Educación Médica e Investigaciones Clínicas "CEMIC", Av. Galván 4102 (1431), Buenos Aires City, Argentina
| | - S Vidaurreta
- Pediatric Department, Centro de Educación Médica e Investigaciones Clínicas "CEMIC", Av. Galván 4102 (1431), Buenos Aires City, Argentina
| | - J Ekstrom
- Pediatric Department, Centro de Educación Médica e Investigaciones Clínicas "CEMIC", Av. Galván 4102 (1431), Buenos Aires City, Argentina
| | - G Carballal
- Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas "CEMIC" - Consejo Nacional de Investigaciones Científicas y Técnicas "CONICET", Av. Galván 4102 (1431), Buenos Aires City, Argentina
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174
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Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study. Br J Gen Pract 2018; 68:e682-e693. [PMID: 30201827 PMCID: PMC6145994 DOI: 10.3399/bjgp18x698873] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/02/2018] [Indexed: 11/16/2022] Open
Abstract
Background Clinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes. Aim To estimate the effect of children’s antibiotic prescribing on adverse outcomes within 30 days of initial consultation. Design and setting Secondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms. Method Baseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians’ propensity to prescribe antibiotics. Results Sixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic risk ratio [RR] 0.83, 95% confidence interval [CI] = 0.47 to 1.45; delayed RR 0.70, 95% CI = 0.26 to 1.90, overall P = 0.44). There was evidence that delayed (rather than immediate) antibiotics reduced reconsultations for deterioration (immediate RR 0.82, 95% CI = 0.65 to 1.07; delayed RR 0.55, 95% CI = 0.34 to 0.88, overall P = 0.024). Conclusion Most children presenting with acute cough and respiratory symptoms in primary care are not at risk of hospitalisation, and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.
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175
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Timbrook TT, Spivak ES, Hanson KE. Current and Future Opportunities for Rapid Diagnostics in Antimicrobial Stewardship. Med Clin North Am 2018; 102:899-911. [PMID: 30126579 DOI: 10.1016/j.mcna.2018.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Rapid diagnostic testing has improved clinical care of patients with infectious syndromes when combined with antimicrobial stewardship. The authors review the current data on antimicrobial stewardship and rapid diagnostic testing in bloodstream, respiratory tract, and gastrointestinal tract infections. Evidence for the potential benefit of rapid tests in bloodstream infections seems strong, respiratory tract infections mixed, and gastrointestinal tract infections still evolving. The authors also review future directions in rapid diagnostic testing and suggest areas of focus for antimicrobial stewardship efforts.
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Affiliation(s)
- Tristan T Timbrook
- Department of Pharmacy, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA
| | - Emily S Spivak
- Department of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA
| | - Kimberly E Hanson
- Department of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA; Institute for Clinical and Experimental Pathology, ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84108, USA; Department of Pathology, University of Utah, 15 North Medical Drive East, Salt Lake City, UT 84112, USA.
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176
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Shaikhan F, Rawaf S, Majeed A, Hassounah S. Knowledge, attitude, perception and practice regarding antimicrobial use in upper respiratory tract infections in Qatar: a systematic review. JRSM Open 2018; 9:2054270418774971. [PMID: 30202533 PMCID: PMC6122249 DOI: 10.1177/2054270418774971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To explore the knowledge, attitude, perception and practice towards antimicrobial use in upper respiratory tract infections in patients visiting healthcare settings in Qatar. DESIGN Systematic review was performed using a predetermined protocol and in accordance with standardized reporting guidelines. MEDLINE, PubMed, EMBASE, Global Health and PsycINFO were searched for relevant published studies using relevant MESH terms and keywords. SETTING All healthcare settings in Qatar including both inpatient and ambulatory care. PARTICIPANTS All published articles exploring the antimicrobial use in upper respiratory tract infections at any health setting in Qatar were considered for inclusion in the study. No age, gender or population were excluded. MAIN OUTCOME MEASURES The outcome of interest was antimicrobial use in upper respiratory tract infections in Qatar. We included all related studies to explore the knowledge, attitude, perception and practice for patients visiting all health care settings. RESULTS Three articles were included, one in a primary care setting, one in a secondary care setting and one in the private sector. Overprescribing was noted in all settings. Our findings demonstrate low expectations to receive antibiotics, among the Qatari population, in primary care (28.1%). In fact, the majority of patients would be satisfied with reassurance rather than receiving antimicrobials. Many patients were satisfied with explanation from physicians and counselling. Private sector registered high prevalence of antimicrobial misuse for respiratory tract infections in which 85% deemed inappropriate. This finding was also noted at a medical intensive care unit which showed high antimicrobial use (76%) and respiratory tract infections accounted for 57% of prescriptions. CONCLUSION Studies are needed to determine factors and population-based rates of antimicrobial use in all healthcare settings. There is also a need for interventional programs for both physicians and public on appropriate use of antimicrobials to combat global antimicrobial resistance.
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Affiliation(s)
- F Shaikhan
- WHO Collaborating Centre for Public
Health Education and Training, Department of Primary Care and Public Health,
Imperial College London, London, UK
| | - S Rawaf
- Department of Primary Care and Public
Health, Imperial College London, London, UK
| | - A Majeed
- Department of Primary Care and Public
Health, Imperial College London, London, UK
| | - S Hassounah
- WHO Collaborating Centre for Public
Health Education and Training, Department of Primary Care and Public Health,
Imperial College London, London, UK
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177
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Song I, Park SJ, Byun SJ, Choe YJ, Shin JY. Increased use of third-generation cephalosporin antibiotics in the outpatient setting in Korean children and adolescents. Pediatr Int 2018; 60:803-810. [PMID: 29947452 DOI: 10.1111/ped.13651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 04/11/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antimicrobial resistance is a concern to public health, and controlling antibiotic use is therefore important. This study analyzed the trend in outpatient antibiotic prescriptions in children and adolescents in Korea. METHODS Using National Prescribing Sample data from the Korea Health Insurance Review and Assessment Service between 1 January 2010 and 31 December 2014, we analyzed outpatient systemic antibiotic (anatomical therapeutic chemical [ATC] J01) prescriptions in patients aged 2-17 years. The antibiotic rate was defined as the proportion of all outpatient prescriptions for antibiotics. We calculated absolute and relative differences with 95%CI between 2010 and 2014 in the antibiotic rate by age group (2-6, 7-11, and 12-17 years) and the percentage of antibiotic prescriptions by antibiotic class. Seven of the most commonly used antibiotic drugs were identified based on defined daily dose. RESULTS A total of 7 261 176 prescriptions were written for 1 039 756 pediatric patients between 2010 and 2014. The antibiotic rate in all patients increased from 34.8% in 2010 to 70.4% in 2014, resulting in the relative difference of 102.1% (95%CI: 101.7-102.5). Extended spectrum penicillins were the most commonly prescribed antibiotic class, accounting for 40.0-41.0% of all antibiotic prescriptions. The use of third-generation cephalosporins increased steeply with the relative difference of 55.7% (95%CI: 55.2-56.2). Amoxicillin/clavulanate, an extended spectrum antibiotic drug, was the predominately used antibiotic drug but the use of cefpodoxime, a third-generation cephalosporin, increased by 96%. CONCLUSIONS The use of outpatient antibiotics, especially third-generation cephalosporins, has increased in children and adolescents in Korea.
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Affiliation(s)
- Inmyung Song
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jun Byun
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-June Choe
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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178
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Zahreddine L, Hallit S, Shakaroun S, Al-Hajje A, Awada S, Lahoud N. Knowledge of pharmacists and parents towards antibiotic use in pediatrics: a cross-sectional study in Lebanon. Pharm Pract (Granada) 2018; 16:1194. [PMID: 30416621 PMCID: PMC6207355 DOI: 10.18549/pharmpract.2018.03.1194] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 07/04/2018] [Indexed: 01/31/2023] Open
Abstract
Objectives to assess the knowledge of both parents and community pharmacists regarding antibiotics use and resistance in pediatrics in Lebanon. Methods A cross-sectional study was conducted between June and August 2017 in community pharmacies. A pre-established questionnaire targeting knowledge of parents and pharmacists regarding antibiotics use/misuse was carried out. An index of knowledge was computed to assess factors associated with good knowledge on antibiotics use/misuse. Results The study showed that 28.7% of pharmacists did not know which factors may contribute to antimicrobial resistance. Concerning the misuse of antibiotics, pharmacists blamed at first parents (90.1%), at second level physicians (72.8%), and third themselves (59.4%). Furthermore, pharmacists believed that the socioeconomic problems of the country (86.1%), the level of resistance to the molecule of choice (80.8%), the lack of consultation time (71.2%) and the lack of national guidelines/recommendations (66.3%) might be additional factors contributing to antimicrobial resistance. In case of acute otitis media, the majority of pharmacists chose the correct treatment, dose and duration according to international guidelines; this was in contrast to the results obtained in case of pharyngitis. Female pharmacists had a significantly higher knowledge score compared to their male counterparts (ORa=2.51). Half of parents (42.6%) declared that antibiotics act against both viruses and bacteria, 55.9% still believe that the presence of fever requires the administration of antibiotics, 50% didn't know the consequences of antibiotics misuse, 58.4% said that it is okay to give their child antibiotics without a physician's advice or based on a pharmacist's recommendation, and 66.7% trusted the pharmacist in the antibiotic prescription. Parents with a university level of education or a master's degree had significantly better knowledge compared to illiterate ones (ORa=9.04 and ORa=16.46, respectively). Conclusions Based on the results obtained, it would be necessary to implement educational campaigns in order to increase awareness on antibiotics misuse and resistance in pediatrics.
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Affiliation(s)
| | - Souheil Hallit
- Faculty of Pharmacy, Lebanese University, Hadat; & Faculty of Medicine and Medical Sciences, Holy Spirit University, Kaslik (Lebanon).
| | | | - Amal Al-Hajje
- Faculty of Pharmacy, Lebanese University, Hadat (Lebanon).
| | - Sanaa Awada
- Faculty of Pharmacy, Lebanese University, Hadat (Lebanon).
| | - Nathalie Lahoud
- Faculty of Pharmacy & Faculty of Public Health, Lebanese University, Hadat (Lebanon).
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179
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Safadi M. Rational use of antimicrobials in upper respiratory tract infections in children. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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180
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Zhang XS, Li J, Krautkramer KA, Badri M, Battaglia T, Borbet TC, Koh H, Ng S, Sibley RA, Li Y, Pathmasiri W, Jindal S, Shields-Cutler RR, Hillmann B, Al-Ghalith GA, Ruiz VE, Livanos A, van 't Wout AB, Nagalingam N, Rogers AB, Sumner SJ, Knights D, Denu JM, Li H, Ruggles KV, Bonneau R, Williamson RA, Rauch M, Blaser MJ. Antibiotic-induced acceleration of type 1 diabetes alters maturation of innate intestinal immunity. eLife 2018; 7:37816. [PMID: 30039798 PMCID: PMC6085123 DOI: 10.7554/elife.37816] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/12/2018] [Indexed: 12/18/2022] Open
Abstract
The early-life intestinal microbiota plays a key role in shaping host immune system development. We found that a single early-life antibiotic course (1PAT) accelerated type 1 diabetes (T1D) development in male NOD mice. The single course had deep and persistent effects on the intestinal microbiome, leading to altered cecal, hepatic, and serum metabolites. The exposure elicited sex-specific effects on chromatin states in the ileum and liver and perturbed ileal gene expression, altering normal maturational patterns. The global signature changes included specific genes controlling both innate and adaptive immunity. Microbiome analysis revealed four taxa each that potentially protect against or accelerate T1D onset, that were linked in a network model to specific differences in ileal gene expression. This simplified animal model reveals multiple potential pathways to understand pathogenesis by which early-life gut microbiome perturbations alter a global suite of intestinal responses, contributing to the accelerated and enhanced T1D development.
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Affiliation(s)
- Xue-Song Zhang
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Jackie Li
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Kimberly A Krautkramer
- Department of Biomolecular Chemistry, Wisconsin Institute for Discovery, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Michelle Badri
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States.,Center for Data Science, New York University, New York, United States
| | - Thomas Battaglia
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Timothy C Borbet
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Hyunwook Koh
- Department of Population Health, New York University Langone Medical Center, New York, United States
| | - Sandy Ng
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Rachel A Sibley
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Yuanyuan Li
- Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, Kannapolis, United States
| | - Wimal Pathmasiri
- Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, Kannapolis, United States
| | - Shawn Jindal
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Robin R Shields-Cutler
- Computer Science and Engineering, BioTechnology Institute, University of Minnesota, St. Paul, United States
| | - Ben Hillmann
- Computer Science and Engineering, BioTechnology Institute, University of Minnesota, St. Paul, United States
| | - Gabriel A Al-Ghalith
- Computer Science and Engineering, BioTechnology Institute, University of Minnesota, St. Paul, United States
| | - Victoria E Ruiz
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Alexandra Livanos
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Angélique B van 't Wout
- Janssen Prevention Center London, Janssen Pharmaceutical Companies of Johnson and Johnson, London, United Kingdom
| | - Nabeetha Nagalingam
- Janssen Prevention Center London, Janssen Pharmaceutical Companies of Johnson and Johnson, London, United Kingdom
| | - Arlin B Rogers
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, United States
| | - Susan Jenkins Sumner
- Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, Kannapolis, United States
| | - Dan Knights
- Computer Science and Engineering, BioTechnology Institute, University of Minnesota, St. Paul, United States
| | - John M Denu
- Department of Biomolecular Chemistry, Wisconsin Institute for Discovery, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Huilin Li
- Department of Population Health, New York University Langone Medical Center, New York, United States
| | - Kelly V Ruggles
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States
| | - Richard Bonneau
- Center for Data Science, New York University, New York, United States
| | - R Anthony Williamson
- Janssen Prevention Center London, Janssen Pharmaceutical Companies of Johnson and Johnson, London, United Kingdom
| | - Marcus Rauch
- Janssen Prevention Center London, Janssen Pharmaceutical Companies of Johnson and Johnson, London, United Kingdom
| | - Martin J Blaser
- Department of Medicine, New York University Langone Medical Center, New York, United States.,Human Microbiome Program, New York University Langone Medical Center, New York, United States.,Department of Microbiology, New York Uniersity Langone Medical Center, New York, United States
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181
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Singer A, Fanella S, Kosowan L, Falk J, Dufault B, Hamilton K, Walus A. Informing antimicrobial stewardship: factors associated with inappropriate antimicrobial prescribing in primary care. Fam Pract 2018; 35:455-460. [PMID: 29237045 DOI: 10.1093/fampra/cmx118] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship (AS) programs promote the optimal use of antimicrobials and safe patient care. With most antimicrobials prescribed in the ambulatory setting, establishing benchmark data is imperative to gauge the impact of future AS initiatives. OBJECTIVES To determine the frequency of potentially inappropriate antimicrobial prescribing in primary care practices in Manitoba, Canada and to assess the association between potentially inappropriate antimicrobial prescribing and patient, prescriber and practice-related factors. METHODS A retrospective cohort study using the Manitoba Primary Care Research Network repository of de-identified Electronic Medical Records from consenting primary care practices. Descriptive statistics and logistic regressions detailed patients with bacterial or viral infections of interest and antimicrobial prescriptions. RESULTS Eighteen percent (n = 35 574) of primary care visits for common infections were associated with a potentially inappropriate antimicrobial prescription. Among antimicrobials prescribed to patients diagnosed with bacterial infections, 37.8% (n = 2168) had a potentially inappropriate antimicrobial prescribed and 19.6% (n = 1126) had an antimicrobial prescribed for a duration outside of guideline-based ranges. Female patients, younger age and less office visits were associated with potentially inappropriate antimicrobial prescribing for bacterial infections. Among physician visits for viral infection, 15.9% (n = 29 833) were associated with an antimicrobial prescription. Older patients, those with more comorbidity, more office visits and those who were seen in larger or rural practices, were associated with potentially inappropriate antimicrobial prescribing for viral infections. CONCLUSIONS High frequency of potentially inappropriate antimicrobial prescribing, especially in certain patient populations, suggests the need for coordinated community-based AS programs to optimize prescribing and improve patient care.
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Affiliation(s)
- Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sergio Fanella
- Department of Pediatrics and Child Health and Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leanne Kosowan
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamie Falk
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brenden Dufault
- George and Fay Yee Center for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Kevin Hamilton
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashley Walus
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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183
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Blanchette L, Gauthier T, Heil E, Klepser M, Kelly KM, Nailor M, Wei W, Suda K. The essential role of pharmacists in antibiotic stewardship in outpatient care: An official position statement of the Society of Infectious Diseases Pharmacists. J Am Pharm Assoc (2003) 2018; 58:481-484. [PMID: 30007508 DOI: 10.1016/j.japh.2018.05.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/15/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this position statement is to describe the essential role of pharmacists in antimicrobial stewardship in outpatient care. DATA SOURCES N/A. SUMMARY The majority of antibiotic prescribing occurs in outpatient care settings highlighting the need for antibiotic stewardship in the community. Given their expertise on medication management, pharmacists are essential to any antibiotic stewardship effort. CONCLUSION As the regulations for antibiotic stewardship in outpatient settings continue to evolve and optimal stewardship strategies are defined, pharmacists must be leaders in the implementation of these programs.
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184
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Alzahrani MS, Maneno MK, Daftary MN, Wingate L, Ettienne EB. Factors Associated with Prescribing Broad-Spectrum Antibiotics for Children with Upper Respiratory Tract Infections in Ambulatory Care Settings. Clin Med Insights Pediatr 2018; 12:1179556518784300. [PMID: 30046262 PMCID: PMC6055249 DOI: 10.1177/1179556518784300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/30/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Broad-spectrum antibiotics are frequently prescribed for children with upper respiratory tract infections (URI). Excessive use of broad-spectrum antibiotics leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics among children younger than 18 years presenting with URI in outpatient settings. METHODS We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010. Descriptive statistics of visits from children with URI were estimated. Simple and multiple logistic regression analyses were used to identify socio-demographic and clinical characteristics associated with broad-spectrum antibiotic prescribing. We also completed a stratified analysis by age (⩽2 vs >2). RESULTS A total of 4013 outpatient visits for children with URI from both NAMCS and NHAMCS-0PD data were examined. Broad-spectrum antibiotics were prescribed in 39% of the visits, accounting for an estimated 6.8 million visits annually. Multivariable analysis showed that visits in the South region (odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.38-4.10) compared with the West region and visits with diagnoses of acute sinusitis (OR = 2.77; 95% CI: 1.65-4.63) and acute otitis media (OR = 1.90; 95% CI: 1.32-2.74) compared with those with acute pharyngitis were associated with greater odds of broad-spectrum antibiotic prescribing. CONCLUSIONS The prescribing of broad-spectrum antibiotics is common for children with URI in ambulatory care settings. Diagnosis and management of URI remain a critical area for awareness campaigns promoting judicious use of antibiotics.
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Affiliation(s)
- Mohammad S Alzahrani
- Department of Clinical and Administrative Pharmacy Sciences, Howard University, Washington, DC, USA
| | - Mary K Maneno
- Department of Clinical and Administrative Pharmacy Sciences, Howard University, Washington, DC, USA
| | - Monika N Daftary
- Department of Clinical and Administrative Pharmacy Sciences, Howard University, Washington, DC, USA
| | - La’Marcus Wingate
- Department of Clinical and Administrative Pharmacy Sciences, Howard University, Washington, DC, USA
| | - Earl B Ettienne
- Department of Clinical and Administrative Pharmacy Sciences, Howard University, Washington, DC, USA
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185
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Outpatient antimicrobial stewardship targets for treatment of skin and soft-tissue infections. Infect Control Hosp Epidemiol 2018; 39:936-940. [PMID: 29962362 DOI: 10.1017/ice.2018.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We sought to identify factors associated with long duration and/or non-first-line choice of treatment for pediatric skin and soft-tissue infections (SSTIs). DESIGN Retrospective cohort study. SETTING Ambulatory encounter claims of Medicaid-insured children lacking chronic medical conditions treated for SSTI and/or animal bite injury in Ohio in 2014. METHODS For all diagnoses, long treatment duration was defined as treatment >7 days. Non-first-line choice of treatment for SSTI included treatment with 2 antimicrobials dispensed on the same calendar day or any treatment not listed in the Infectious Diseases Society of America guidelines. The adjusted odds of (1) long treatment duration and (2) non-first-line choice of treatment were calculated for patient age, prescriber type, and patient county of residence characteristics (ie, rural vs metropolitan area and poverty rate). RESULTS Of 10,310 encounters with complete data available, long treatment duration was prescribed in 7,968 (77.3%). The most common duration of treatment prescribed was 10 days. A non-first-line choice was prescribed in 1,030 encounters (10%). Dispensation of 2 antimicrobials on the same calendar day was the most common reason for the non-first-line choice, and of these, trimethoprim-sulfamethoxazole plus a first-generation cephalosporin was the most common regimen. Compared to pediatricians, the adjusted odds ratio of long treatment duration was significantly lower for all other primary care specialties. Conversely, nonpediatricians were more likely to prescribe a non-first-line treatment choice. Patient residence in a high-poverty county increased the odds of both long duration and non-first-line choice of treatment. CONCLUSIONS Healthcare claims may be utilized to measure opportunities for first-line choice and/or shorter duration of treatment for SSTI.
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186
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Global Distribution of Invasive Serotype 35D Streptococcus pneumoniae Isolates following Introduction of 13-Valent Pneumococcal Conjugate Vaccine. J Clin Microbiol 2018; 56:JCM.00228-18. [PMID: 29720431 PMCID: PMC6018339 DOI: 10.1128/jcm.00228-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/24/2018] [Indexed: 02/08/2023] Open
Abstract
A newly recognized pneumococcal serotype, 35D, which differs from the 35B polysaccharide in structure and serology by not binding to factor serum 35a, was recently reported. The genetic basis for this distinctive serology is due to the presence of an inactivating mutation in wciG, which encodes an O-acetyltransferase responsible for O-acetylation of a galactofuranose. Here, we assessed the genomic data of a worldwide pneumococcal collection to identify serotype 35D isolates and understand their geographical distribution, genetic background, and invasiveness potential. Of 21,980 pneumococcal isolates, 444 were originally typed as serotype 35B by PneumoCaT. Analysis of the wciG gene revealed 23 isolates from carriage (n = 4) and disease (n = 19) with partial or complete loss-of-function mutations, including mutations resulting in premature stop codons (n = 22) and an in-frame mutation (n = 1). These were selected for further analysis. The putative 35D isolates were geographically widespread, and 65.2% (15/23) of them was recovered after the introduction of pneumococcal conjugate vaccine 13 (PCV13). Compared with serotype 35B isolates, putative serotype 35D isolates have higher invasive disease potentials based on odds ratios (OR) (11.58; 95% confidence interval[CI], 1.42 to 94.19 versus 0.61; 95% CI, 0.40 to 0.92) and a higher prevalence of macrolide resistance mediated by mefA (26.1% versus 7.6%; P = 0.009). Using the Quellung reaction, 50% (10/20) of viable isolates were identified as serotype 35D, 25% (5/20) as serotype 35B, and 25% (5/20) as a mixture of 35B/35D. The discrepancy between phenotype and genotype requires further investigation. These findings illustrated a global distribution of an invasive serotype, 35D, among young children post-PCV13 introduction and underlined the invasive potential conferred by the loss of O-acetylation in the pneumococcal capsule.
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Preparing Parents to Make An Informed Choice About Antibiotic Use for Common Acute Respiratory Infections in Children: A Randomised Trial of Brief Decision Aids in a Hypothetical Scenario. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 10:463-474. [PMID: 28258505 DOI: 10.1007/s40271-017-0223-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Childhood acute respiratory infections (ARIs) are one of the most common reasons for primary care consultations and for receiving an antibiotic. Public awareness of antibiotic benefit and harms for these conditions is low. To facilitate informed decision making, ideally in collaboration with their doctor, parents need clear communication about benefits and harms. Decision aids may be able to facilitate this process. OBJECTIVE The aim of this study was to evaluate the effectiveness of three decision aids about antibiotic use for common ARIs in children. METHODS Adult parents of children aged 1-16 years (n = 120) were recruited from community settings and then randomised using a computer-generated randomisation sequence to receive a decision aid (n = 60) or fact sheet (n = 60). Allocation was concealed and used sealed and opaque sequentially numbered envelopes. Participants self-completed questionnaires at baseline and immediately post-intervention. The primary outcome was informed choice (conceptual and numerical knowledge; attitudes towards, and intention to use, antibiotics for a future ARI). Secondary outcomes were decisional conflict, decisional self-efficacy, and material acceptability. RESULTS After reading the information, significantly more intervention group participants made an informed choice [57%] compared with control group participants [29%] [difference 28, 95% confidence interval (CI) 11-45%, p < 0.01], and had higher total knowledge [mean difference (MD) 2.8, 95% CI 2.2-3.5, p < 0.01], conceptual knowledge (MD 0.7, 95% CI 0.4-1.1, p < 0.01) and numerical knowledge (MD 2.1, 95% CI 1.6-2.5, p < 0.01). Between-group differences in attitudes or intention to use antibiotics were not significant. Most intervention group participants found the information understandable and liked the aids' format and features. CONCLUSION The decision aids prepared parents to make an informed choice about antibiotic use more than fact sheets, in a hypothetical situation. Their effect within a consultation needs to be evaluated. Clinical Trials Registration Number: ACTRN12615000843550.
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Goggin K, Bradley-Ewing A, Myers AL, Lee BR, Hurley EA, Delay KB, Schlachter S, Ramphal A, Pina K, Yu D, Weltmer K, Linnemayr S, Butler CC, Newland JG. Protocol for a randomised trial of higher versus lower intensity patient-provider communication interventions to reduce antibiotic misuse in two paediatric ambulatory clinics in the USA. BMJ Open 2018; 8:e020981. [PMID: 29743330 PMCID: PMC5942422 DOI: 10.1136/bmjopen-2017-020981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Children with acute respiratory tract infections (ARTIs) are prescribed up to 11.4 million unnecessary antibiotic prescriptions annually. Inadequate parent-provider communication is a chief contributor, yet efforts to reduce overprescribing have only indirectly targeted communication or been impractical. This paper describes our multisite, parallel group, cluster randomised trial comparing two feasible interventions for enhancing parent-provider communication on the rate of inappropriate antibiotic prescribing (primary outcome) and revisits, adverse drug reactions and parent-rated quality of shared decision-making, parent-provider communication and visit satisfaction (secondary outcomes). METHODS/ANALYSIS We will attempt to recruit all eligible paediatricians and nurse practitioners (currently 47) at an academic children's hospital and a private practice. Using a 1:1 randomisation, providers will be assigned to a higher intensity education and communication skills or lower intensity education-only intervention and trained accordingly. We will recruit 1600 eligible parent-child dyads. Parents of children ages 1-5 years who present with ARTI symptoms will be managed by providers trained in either the higher or lower intensity intervention. Before their consultation, all parents will complete a baseline survey and view a 90 s gain-framed antibiotic educational video. Parent-child dyads consulting with providers trained in the higher intensity intervention will, in addition, receive a gain-framed antibiotic educational brochure promoting cautious use of antibiotics and rate their interest in receiving an antibiotic which will be shared with their provider before the visit. All parents will complete a postconsultation survey and a 2-week follow-up phone survey. Due to the two-stage nested design (parents nested within providers and clinics), we will employ generalised linear mixed-effect regression models. ETHICS/DISSEMINATION Ethical approval was obtained from the Children's Mercy Hospital Pediatric Institutional Review Board (#16060466). Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03037112; Pre-results.
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Affiliation(s)
- Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
- School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Andrea Bradley-Ewing
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Angela L Myers
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
- Infectious Diseases, Children's Mercy, Kansas City, Missouri, USA
| | - Brian R Lee
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Emily A Hurley
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Kirsten B Delay
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Sarah Schlachter
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Areli Ramphal
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Kimberly Pina
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - David Yu
- Sunflower Medical Group, Kansas City, Kansas, USA
| | - Kirsten Weltmer
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jason G Newland
- Pediatric Infectious Disease, St. Louis Children's Hospital, St. Louis, Missouri, USA
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Ahmadizar F, Vijverberg SJH, Arets HGM, de Boer A, Lang JE, Garssen J, Kraneveld A, Maitland-van der Zee AH. Early-life antibiotic exposure increases the risk of developing allergic symptoms later in life: A meta-analysis. Allergy 2018; 73:971-986. [PMID: 29105784 DOI: 10.1111/all.13332] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 01/01/2023]
Abstract
This study systematically reviewed and quantified the relationship between exposure to antibiotics during the first 2 years of life and the risk of allergies/atopies including hay fever, eczema, food allergy, positive skin prick testing (SPT), or elevated allergen-specific serum/plasma immunoglobulin (Ig) E levels later in life. PubMed and Web of Science databases were searched for observational studies published from January 1966 through November 11, 2015. Overall pooled estimates of the odds ratios (ORs) were obtained using fixed or random-effects models. Early-life exposure to antibiotics appears to be related to an increased risk of allergic symptoms of hay fever, eczema, and food allergy later in life. The summary OR for the risk of hay fever (22 studies) was 1.23, 95% confidence interval (CI):1.13-1.34; I2 : 77.0%. The summary OR for the risk of eczema (22 studies) was 1.26, 95% CI: 1.15-1.37; I2 : 74.2%, and the summary OR for food allergy (3 studies) was 1.42, 95% CI: 1.08-1.87; I2 : 80.8%. However, no association was found for antibiotics exposure early in life and objective atopy measurements including positive SPT or elevated allergen-specific serum/plasma IgE levels.
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Affiliation(s)
- F. Ahmadizar
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
| | - S. J. H. Vijverberg
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - H. G. M. Arets
- Department of Pediatric Pulmonology and Allergology; Department of Pediatrics; University Medical Centre Utrecht; Utrecht The Netherlands
| | - A. de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
| | - J. E. Lang
- Division of Pulmonary and Sleep Medicine; Nemours Children's Hospital; Orlando FL USA
| | - J. Garssen
- Division of Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
- Nutricia Research; Utrecht The Netherlands
| | - A. Kraneveld
- Division of Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
| | - A. H. Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
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190
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Newton L, Kotowski A, Grinker M, Chun R. Diagnosis and management of pediatric sinusitis: A survey of primary care, otolaryngology and urgent care providers. Int J Pediatr Otorhinolaryngol 2018; 108:163-167. [PMID: 29605347 DOI: 10.1016/j.ijporl.2018.02.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aims of this project were two-fold: 1) To assess pediatric primary care (PCP), pediatric otolaryngology (ENT) and pediatric urgent care (UC) providers' perception of their adherence to the 2013 American Academy of Pediatrics (AAP) established guidelines for the diagnosis and management of acute bacterial rhinosinusitis (ABRS) in children 1-18 years old and 2) to assess the same providers' practice patterns in the diagnosis and management of pediatric chronic rhinosinusitis (PCRS). METHOD A 21-item questionnaire (CVI .9) was designed by th investigators using Survey Monkey®. The survey was emailed to pediatric providers (including physicians and advanced practice providers) in a Midwestern USA healthcare system (94 PCP, 25 UC, 19 ENT providers) from 20 pediatric primary care practices, 1 pediatric UC practice and 1 pediatric otolaryngology practice. RESULTS Diagnosis: The following diagnostic criteria are utilized: persistent nasal congestion/cough lasting >10 days (95%), worsening of classic viral URI symptoms at days 5-7 (70%), severe onset and purulent nasal discharge for at least 3 consecutive days (45%). ENT will most commonly culture their patients. ENT providers (57%) approve of a nasal culture being obtained by PCPs. MANAGEMENT Typically used antibiotics: amoxicillin (72%), Amoxicillin-clavulanic acid (98%), cefdinir (73%), azithromycin (15%). ENT providers will also use clarithromycin and Bactrim more often compared to PCPs. For PCN allergy patients, most providers choose cefdinir. Typical length of antibiotic therapy for providers is 10 days (70%) and 14 days (17%); ENT (21%) prescribes 7 days past any symptom compared to PCP (6%) and UC (5%). Use of adjuvant therapy is variable among the groups. CONCLUSION This quality initiative project demonstrates that providers' diagnosis of ABRS is consistent with the 2013 AAP guidelines while variation in clinical management exists for both ABRS and PCRS. This survey demonstrates the need to educate all providers on the current 2013 AAP guidelines and define practice across all settings.
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Affiliation(s)
- Laurie Newton
- Children's Hospital of Wisconsin / Medical College of Wisconsin - Milwaukee, 8915 W. Cornell Ct., Milwaukee, WI 53226, United States.
| | - Amanda Kotowski
- Children's Hospital of Wisconsin, 8915 W. Cornell Ct., Milwaukee, WI 53226, United States.
| | - Melissa Grinker
- Children's Hospital of Wisconsin, 8915 W. Cornell Ct., Milwaukee, WI 53226, United States.
| | - Robert Chun
- Children's Hospital of Wisconsin / Medical College of Wisconsin - Milwaukee, 8915 W. Cornell Ct., Milwaukee, WI 53226, United States.
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Trippella G, Galli L, de Martino M, Chiappini E. Inflammatory biomarkers to guide diagnostic and therapeutic decisions in children presenting with fever without apparent source. J Chemother 2018; 30:255-265. [DOI: 10.1080/1120009x.2018.1451430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Giulia Trippella
- Department of Health Science, Post-graduate School of Pediatrics, Anna Meyer Children’s University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Division of Pediatric Infectious Disease, Department of Health Science, Anna Meyer Children’s University Hospital, University of Florence, Florence, Italy
| | | | - Elena Chiappini
- Division of Pediatric Infectious Disease, Department of Health Science, Anna Meyer Children’s University Hospital, University of Florence, Florence, Italy
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192
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Miyoshi J, Bobe AM, Miyoshi S, Huang Y, Hubert N, Delmont TO, Eren AM, Leone V, Chang EB. Peripartum Antibiotics Promote Gut Dysbiosis, Loss of Immune Tolerance, and Inflammatory Bowel Disease in Genetically Prone Offspring. Cell Rep 2018; 20:491-504. [PMID: 28700948 DOI: 10.1016/j.celrep.2017.06.060] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/07/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
Factors affecting the developing neonatal gut microbiome and immune networks may increase the risk of developing complex immune disorders such as inflammatory bowel diseases (IBD). In particular, peripartum antibiotics have been suggested as risk factors for human IBD, although direct evidence is lacking. Therefore, we examined the temporal impact of the commonly used antibiotic cefoperazone on both maternal and offspring microbiota when administered to dams during the peripartum period in the IL-10-deficient murine colitis model. By rigorously controlling for cage, gender, generational, and murine pathobiont confounders, we observed that offspring from cefoperazone-exposed dams develop a persistent gut dysbiosis into adulthood associated with skewing of the host immune system and increased susceptibility to spontaneous and chemically dextran sodium sulfate (DSS)-induced colitis. Thus, early life exposure to antibiotic-induced maternal dysbiosis during a critical developmental window for gut microbial assemblage and immune programming elicits a lasting impact of increased IBD risk on genetically susceptible offspring.
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Affiliation(s)
- Jun Miyoshi
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA
| | - Alexandria M Bobe
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA
| | - Sawako Miyoshi
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA
| | - Yong Huang
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA
| | - Nathaniel Hubert
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA
| | - Tom O Delmont
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA
| | - A Murat Eren
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA
| | - Vanessa Leone
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA
| | - Eugene B Chang
- Department of Medicine, Knapp Center for Biomedical Discovery, The University of Chicago, 900 E. 57th Street, Chicago, IL 60637, USA.
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Miyoshi J, Qiao Y, Chang EB. The role of the intestinal microbiota in the pathogenesis and treatment of inflammatory bowel diseases. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kamin W, Funk P, Seifert G, Zimmermann A, Lehmacher W. EPs 7630 is effective and safe in children under 6 years with acute respiratory tract infections: clinical studies revisited. Curr Med Res Opin 2018; 34:475-485. [PMID: 29119837 DOI: 10.1080/03007995.2017.1402754] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Pelargonium sidoides preparation EPs 7630 has been proven safe and effective in acute respiratory tract infections (aRTIs), but data for young children have not been presented separately. This study reviewed clinical studies and presents an overview of known and newly analyzed data from children <6 years. METHODS MEDLINE and EMBASE were searched for interventional and non-interventional studies which investigated the effects of EPs 7630 in aRTIs and included children <6 years of age. Sub-group analyses for this age range were performed for symptom scales, global efficacy or effectiveness assessments, and safety outcomes. RESULTS Seven studies with 1067 children <6 years exposed to EPs 7630 were identified. Efficacy of EPs 7630 was significantly superior to placebo in reducing symptom intensity and time until complete recovery in two randomized, double-blind trials in patients with acute bronchitis (AB). Similar symptom time courses were observed in two non-comparative observational studies in AB. One non-comparative, open-label study was identified in acute tonsillopharyngitis (ATP), and one in acute rhinosinusitis (ARS). In both indications, nearly all children showed complete recovery or major symptom improvements during the treatment period, with changes that were similar to those observed in controlled trials investigating older patient populations. The results were supported by an additional observational study including children with various diagnoses of aRTIs. EPs 7630 was safe and well-tolerated. CONCLUSIONS EPs 7630 is efficacious in children <6 years suffering from AB. The analyses also support the effectiveness of the product in ATP and in ARS. No safety concerns were identified.
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Affiliation(s)
- Wolfgang Kamin
- a Clinic for Paediatrics , Evangelic Hospital Hamm , Hamm , Germany
| | - Petra Funk
- b Clinical Research Department , Dr. Willmar Schwabe GmbH & Co. KG , Karlsruhe , Germany
| | - Georg Seifert
- c Clinic for Paediatrics , Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Andrea Zimmermann
- b Clinical Research Department , Dr. Willmar Schwabe GmbH & Co. KG , Karlsruhe , Germany
| | - Walter Lehmacher
- d Institute for Medical Statistics, Informatics and Epidemiology of the University of Cologne , Cologne , Germany
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195
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Watson JR, Wang L, Klima J, Moore-Clingenpeel M, Gleeson S, Kelleher K, Jaggi P. Healthcare Claims Data: An Underutilized Tool for Pediatric Outpatient Antimicrobial Stewardship. Clin Infect Dis 2018; 64:1479-1485. [PMID: 28329388 DOI: 10.1093/cid/cix195] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/06/2017] [Indexed: 11/13/2022] Open
Abstract
Background. Healthcare claims are underutilized to identify factors associated with high outpatient antibiotic use. Methods. We evaluated ambulatory encounter claims of Medicaid-insured children in 34 Ohio counties in 2014. Rates of total antibiotic and azithromycin prescriptions dispensed were determined by county of patient residence. Standardized treatment rates by county were estimated for uncomplicated upper respiratory tract encounters (acute otitis media, pharyngitis, sinusitis, presumed viral infection) after adjusting for patient age and encounter provider type. Uncomplicated encounters included healthy children at initial presentation of illness. Adjusted odds of treatment were calculated for patient age, provider type, and county characteristics (rural vs metropolitan; poverty rate). Results. Retail pharmacies dispensed 255291 antibiotics to this cohort in 2014. More than 25% were to children <3 years. County rates of total antibiotic and azithromycin prescriptions dispensed were 530.4-1548.3 and 57.3-378.7 per 1000 person-years, respectively. Of 246866 uncomplicated upper respiratory tract encounters, antibiotics were dispensed (within 3 days) in 46.1%. Presumed viral infection accounted for 18.5% of antibiotics. Standardized treatment rates by county ranged widely from 35.9% (95% confidence interval [CI], 33.3%-38.5%) to 63.2% (95% CI, 61.5%-64.9%). Compared to encounters with pediatricians, adjusted odds ratio of treatment was 2.02 (95% CI, 1.96-2.07) for family physicians and 1.74 (95% CI, 1.68-1.79) for nurse practitioners. Residence in rural or high-poverty counties increased odds of treatment. Conclusions. Healthcare claims were useful to identify populations and providers with high antibiotic use. Claims data could be considered to track and report antibiotic prescribing frequency, especially where electronic medical records are not available.
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Affiliation(s)
- Joshua R Watson
- Department of Pediatrics, The Ohio State University.,Nationwide Children's Hospital, Partners for Kids ; and
| | - Ling Wang
- Nationwide Children's Hospital, Partners for Kids; and
| | | | | | - Sean Gleeson
- Department of Pediatrics, The Ohio State University.,Nationwide Children's Hospital, Partners for Kids ; and
| | - Kelly Kelleher
- Department of Pediatrics, The Ohio State University.,Nationwide Children's Hospital, Partners for Kids ; and
| | - Preeti Jaggi
- Department of Pediatrics, The Ohio State University.,Nationwide Children's Hospital, Partners for Kids ; and
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Labi AK, Obeng-Nkrumah N, Nartey ET, Bjerrum S, Adu-Aryee NA, Ofori-Adjei YA, Yawson AE, Newman MJ. Antibiotic use in a tertiary healthcare facility in Ghana: a point prevalence survey. Antimicrob Resist Infect Control 2018; 7:15. [PMID: 29423190 PMCID: PMC5787245 DOI: 10.1186/s13756-018-0299-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/09/2018] [Indexed: 12/01/2022] Open
Abstract
Background The global rise and spread of antibiotic resistance is limiting the usefulness of antibiotics in the prevention and treatment of infectious diseases. The use of antibiotic stewardship programs guided by local data on prescribing practices is a useful strategy to control and reduce antibiotic resistance. Our objective in this study was to determine the prevalence and indications for use of antibiotics at the Korle-Bu Teaching Hospital Accra, Ghana. Methods An antibiotic point prevalence survey was conducted among inpatients of the Korle-Bu Teaching Hospital between February and March 2016. Folders and treatment charts of patients on admission at participating departments were reviewed for antibiotics administered or scheduled to be administered on the day of the survey. Data on indication for use were also collected. Prevalence of antibiotic use was determined by dividing the number of inpatients on antibiotics at the time of survey by the total number of patients on admission. Results Of the 677 inpatients surveyed, 348 (51.4%, 95% CI, 47.6–55.2) were on treatment with antibiotics. Prevalence was highest among Paediatric surgery where 20/22 patients (90.9%, 95% CI, 70.8–98.9) were administered antibiotics and lowest among Obstetrics patients with 77/214 (36%, 95% CI, 29.5–42.8). The indications for antibiotic use were 245/611 (40.1%) for community-acquired infections, 205/611 (33.6%) for surgical prophylaxis, 129/611 (21.1%) for healthcare associated infections and 33/611 (5.4%) for medical prophylaxis. The top five antibiotics prescribed in the hospital were metronidazole 107 (17.5%), amoxicillin-clavulinic acid 82 (13.4%), ceftriaxone 17(12.1%), cefuroxime 61 (10.0%), and cloxacillin 52 (8.5%) respectively. Prevalence of meropenem and vancomycin use was 12(2%) and 1 (.2%) respectively. The majority of patients 181 (52%) were being treated with two antibiotics. Conclusion This study indicated a high prevalence of antibiotic use among inpatients at the Korle-Bu Teaching Hospital. Metronidazole was the most commonly used antibiotic; mainly for surgical prophylaxis. There is the need to further explore factors contributing to the high prevalence of antibiotic use and develop strategies for appropriate antibiotic use in the hospital. Electronic supplementary material The online version of this article (10.1186/s13756-018-0299-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Appiah-Korang Labi
- 1Department of Microbiology, Korle-Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Accra, Ghana
| | - Edmund Tetteh Nartey
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, P.O. Box 4236, Accra, Ghana
| | - Stephanie Bjerrum
- 4Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Nii Armah Adu-Aryee
- 5Department of Surgery, University of Ghana School of Medicine and Dentistry, P.O. Box 4326, Accra, Ghana
| | | | - Alfred E Yawson
- 7Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Mercy J Newman
- Department of Medical Microbiology, School of Biomedical and Allied Sciences, P.O. Box KB 143, Accra, Ghana
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Variations in Antibiotic and Azithromycin Prescribing for Children by Geography and Specialty-United States, 2013. Pediatr Infect Dis J 2018; 37:52-58. [PMID: 28746259 PMCID: PMC6622452 DOI: 10.1097/inf.0000000000001708] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Using antibiotics appropriately is critical to slow spread of antibiotic resistance, a major public health problem. Children, especially young children, receive more antibiotics than other age groups. Our objective was to describe antibiotic use in children in the United States and use of azithromycin, which is recommended infrequently for pediatric conditions. METHODS We used QuintilesIMS Xponent 2013 data to calculate the number and rate of oral antibiotic prescriptions for children by age (0-2, 3-9 and 10-19 years) and agent. We used log-binomial regression to calculate adjusted prevalence ratios and 95% confidence intervals to determine if specialty and patient age were associated with azithromycin selection when an antibiotic was prescribed. RESULTS In 2013, 66.8 million antibiotics were prescribed to US children ≤19 years of age (813 antibiotic prescriptions per 1000 children). Amoxicillin and azithromycin were the 2 most commonly prescribed agents (23.1 million courses, 35% of all antibiotics; 12.2 million, 18%, respectively). Most antibiotics for children were prescribed by pediatricians (39%) and family practitioners (15%). Family practitioners were more likely to select azithromycin when an antibiotic was prescribed in all age groups than pediatricians (for children 0-2 years of age: prevalence ratio: 1.79, 95% confidence interval: 1.78-1.80; 3-9 years: 1.40, 1.40-1.40 and 10-19 years: 1.18, 1.18-1.18). CONCLUSION Despite infrequent pediatric recommendations, variations in pediatric azithromycin use may suggest inappropriate antibiotic selection. Public health interventions focused on improving antibiotic selection in children as well as reducing antibiotic overuse are needed.
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198
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Tripathy JP, Bahuguna P, Prinja S. Drug prescription behavior: A cross-sectional study in public health facilities in two states of North India. Perspect Clin Res 2018; 9:76-82. [PMID: 29862200 PMCID: PMC5950614 DOI: 10.4103/picr.picr_75_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Poor prescription practices result in increased side effects, adverse drug reactions, and high cost of treatment. The present study was undertaken to describe the drug-prescribing patterns in two North Indian states through prescription auditing. Materials and Methods: The study was carried out in 80 public health facilities across 12 districts in two states of Haryana and Punjab (6 in each) covering all levels of care. The information from prescription slips was abstracted on a structured pro forma for all patients who visited the pharmacy of the health facility. Results: A total of 1609 prescriptions were analyzed. On an average, 2.2 drugs were prescribed per patient. Nearly 84% of the drugs were prescribed from the essential drug list (EDL). Antibiotics were prescribed in 45.3% of prescriptions, followed by vitamins (34.8%) and nonsteroidal anti-inflammatory drugs (33.9%). Drugs were prescribed in their generic names in 70% of cases. Diseases of the ear, nose, and throat (18%) were most common followed by the diseases of the gastrointestinal and renal (17%) and musculoskeletal system (16%). Only 40% of children suffering from diarrhea received oral rehydration salts while 80% of them received antibiotics. Among cases of upper respiratory tract infection, nearly 75% received antibiotics. Conclusion: The results of this study raise concerns about the overuse of antibiotics although most of the drugs (84%) were from the EDL and in generic names (70%). There is lack of data regarding prescription practices which necessitates real-time prescription monitoring through online data entry and transmission.
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Affiliation(s)
- Jaya Prasad Tripathy
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.,School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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199
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Ellegård LM, Dietrichson J, Anell A. Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics? HEALTH ECONOMICS 2018; 27:e39-e54. [PMID: 28685902 PMCID: PMC5836891 DOI: 10.1002/hec.3535] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 05/05/2023]
Abstract
Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow-spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay-for-performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006-2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow-spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference-in-differences analysis, we find that P4P significantly increased the share of narrow-spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall.
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Affiliation(s)
| | - Jens Dietrichson
- SFIThe Danish National Centre for Social ResearchCopenhagenDenmark
| | - Anders Anell
- Department of Business AdministrationLund UniversityLundSweden
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200
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Tsalik EL, Petzold E, Kreiswirth BN, Bonomo RA, Banerjee R, Lautenbach E, Evans SR, Hanson KE, Klausner JD, Patel R. Advancing Diagnostics to Address Antibacterial Resistance: The Diagnostics and Devices Committee of the Antibacterial Resistance Leadership Group. Clin Infect Dis 2017; 64:S41-S47. [PMID: 28350903 DOI: 10.1093/cid/ciw831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diagnostics are a cornerstone of the practice of infectious diseases. However, various limitations frequently lead to unmet clinical needs. In most other domains, diagnostics focus on narrowly defined questions, provide readily interpretable answers, and use true gold standards for development. In contrast, infectious diseases diagnostics must contend with scores of potential pathogens, dozens of clinical syndromes, emerging pathogens, rapid evolution of existing pathogens and their associated resistance mechanisms, and the absence of gold standards in many situations. In spite of these challenges, the importance and value of diagnostics cannot be underestimated. Therefore, the Antibacterial Resistance Leadership Group has identified diagnostics as 1 of 4 major areas of emphasis. Herein, we provide an overview of that development, highlighting several examples where innovation in study design, content, and execution is advancing the field of infectious diseases diagnostics.
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Affiliation(s)
- Ephraim L Tsalik
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, and.,Emergency Medicine Service, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Elizabeth Petzold
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, and
| | - Barry N Kreiswirth
- Public Health Research Institute Tuberculosis Center, New Jersey Medical School-Rutgers University, Newark
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, and.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Ritu Banerjee
- Division of Pediatric Infectious Diseases, Vanderbilt University, Nashville, Tennessee
| | - Ebbing Lautenbach
- Department of Medicine, Division of Infectious Diseases, the University of Pennsylvania School of Medicine, Philadelphia
| | - Scott R Evans
- Center for Biostatistics in AIDS Research and the Department of Biostatistics, Harvard University, Boston, Massachusetts
| | - Kimberly E Hanson
- Departments of Medicine and Pathology, Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City
| | - Jeffrey D Klausner
- UCLA David Geffen School of Medicine and Fielding School of Public Health, Los Angeles, California
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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