201
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Song YK, Han N, Kim MG, Chang HJ, Sohn HS, Ji E, Oh JM. A national pharmacoepidemiological study of antibiotic use in Korean paediatric outpatients. Arch Dis Child 2017; 102:660-666. [PMID: 28119402 DOI: 10.1136/archdischild-2016-310981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Information on the use of antibiotics in Eastern Asian children is limited. The objectives of this study were to evaluate in Korean paediatric outpatients (1) the nationwide pattern of prescribing antibiotics according to age group and medical institution and (2) the adherence of antibiotic use for acute respiratory tract infections to both national guidelines and European antibiotic prescribing quality indicators. METHOD This population-based study used the national insurance reimbursement database for 2011. The study subjects were outpatients younger than 18 years old prescribed systemic antibiotics. Patterns of antibiotic prescription were compared according to diagnostic conditions, age group and medical institution. The disease-specific proportion of recommended antibiotic or quinolone use for acute respiratory tract infections was evaluated on the basis of clinical practice guidelines and European quality indicators. RESULTS The data consisted of 70.7 million prescription records for 7.9 million paediatric outpatients, which means that 79.3% of the whole paediatric population used antibiotics. Broad-spectrum antibiotics made up 78.5% of the prescriptions, with broad-spectrum penicillins such as amoxicillin/clavulanate being the most commonly prescribed (50.2%). They were prescribed more commonly in younger paediatric patients (∼80%) than in adolescents (66.6%). The leading diagnosis accounting for antibiotic prescription was bronchitis (35.9%). The prescription proportion of recommended antibiotics in the European quality indicators was extremely low compared with the national guidelines: <0.1% for pharyngotonsillitis and 13.4% for acute otitis media. CONCLUSIONS Antibiotic use in children in Korea is inappropriately high. In addition, broad-spectrum antibiotics are used excessively.
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Affiliation(s)
- Yun-Kyoung Song
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Nayoung Han
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Myeong Gyu Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyeu-Jin Chang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyun Soon Sohn
- College of Pharmacy, CHA University, Gyeonggi-do, Republic of Korea
| | - Eunhee Ji
- College of Pharmacy, Gachon University, Incheon, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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202
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203
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Cevc G. Differential diagnosis and proper treatment of acute rhinosinusitis: Guidance based on historical data analysis. ALLERGY & RHINOLOGY 2017; 8:45-52. [PMID: 28583227 PMCID: PMC5468756 DOI: 10.2500/ar.2017.8.0206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: The time course of rhinovirus positive and negative rhinosinusitis has not been quantified yet, which aggravates proper selection and justification of the optimum treatment for this illness. Such quantitative information would facilitate an early and proper identification of the disease and its differentiation from acute bacterial rhinosinusitis, and could diminish harmful overuse of antibiotics, arguably driven by patients' want for attention and the treating physicians' inability to offer an adequate verbal comfort in its stead. Objective: Extraction of the quantitative information needed to identify rhinovirus positive or negative rhinosinusitis and to allow selection of the most appropriate treatment from the published time dependence of individual clinical symptoms of the disease. Methods: Scrutiny (and modeling) of temporal evolution of all noteworthy symptoms of rhinosinusitis with a simple mathematical expression that relies on two adjustable parameters per symptom (and potentially a general time offset as an extra adjustable parameter). Results: Adverse effects of rhinosinusitis can be grouped according to the sequence of their exponential appearance and ∼2.6 times slower exponential disappearance, rhinovirus negative rhinosinusitis generally improving ∼25% faster and being ∼40% less severe. The major early local symptoms (throat soreness and scratchiness, headache) vanish with a half-life of ∼1.8 days, whereas further local symptoms take ∼1.6 times longer to disappear. At least 50–60% improvement of two prominent early symptoms, sore throat and sneezing (but not of nasal discharge, cough, and hoarseness) by day 5 of the disease implies a nonbacterial origin of rhinitis and should exclude use of antibiotics. Conclusion: Temporal evolution of all rhinosinusitis symptoms is qualitatively similar, which makes the early symptom decay a good proxy for, and predictor of, the disease perspective. Knowing a symptom intensity at just three to four time points suffices for reconstructing its entire time course and total intensity or gravity. This permits an easy and early identification of rhinosinusitis, and its plausible differentiation from acute bacterial rhinosinusitis, disease treatment optimization, and corresponding clinical trials simplification and/or shortening.
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Affiliation(s)
- Gregor Cevc
- From the Advanced Treatments Institute, Gauting, Germany
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204
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Principi N, Esposito S. Nasal Irrigation: An Imprecisely Defined Medical Procedure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14050516. [PMID: 28492494 PMCID: PMC5451967 DOI: 10.3390/ijerph14050516] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 12/29/2022]
Abstract
Nasal irrigation (NI) is an old practice of upper respiratory tract care that likely originated in the Ayurvedic medical tradition. It is used alone or in association with other therapies in several conditions—including chronic rhinosinusitis and allergic rhinitis—and to treat and prevent upper respiratory tract infections, especially in children. However, despite it being largely prescribed in everyday clinical practice, NI is not included or is only briefly mentioned by experts in the guidelines for treatment of upper respiratory tract diseases. In this review, present knowledge about NI and its relevance in clinical practice is discussed to assist physicians in understanding the available evidence and the potential use of this medical intervention. Analysis of the literature showed that NI seems to be effective in the treatment of several acute and chronic sinonasal conditions. However, although in recent years several new studies have been performed, most of the studies that have evaluated NI have relevant methodologic problems. Only multicenter studies enrolling a great number of subjects can solve the problem of the real relevance of NI, and these studies are urgently needed. Methods for performing NI have to be standardized to determine which solutions, devices and durations of treatment are adequate to obtain favorable results. This seems particularly important for children that suffer a great number of sinonasal problems and might benefit significantly from an inexpensive and simple preventive and therapeutic measure such as NI.
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Affiliation(s)
- Nicola Principi
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
| | - Susanna Esposito
- Pediatric Clinic, Università degli Studi di Perugia, 06123 Perugia, Italy.
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205
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Iwata K, Fukuchi T, Hirai M, Yoshimura K, Kanatani Y. Prevalence of inappropriate antibiotic prescriptions after the great east Japan earthquake, 2011. Medicine (Baltimore) 2017; 96:e6625. [PMID: 28403114 PMCID: PMC5403111 DOI: 10.1097/md.0000000000006625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Few studies have investigated the appropriateness of antibiotic use in postdisaster settings. We retrospectively evaluated clinical databases on health care delivered at clinics near shelters set up after the Great East Japan Earthquake, 2011. We defined appropriate, acceptable, and inappropriate antibiotic use for each diagnostic category, by applying and adopting precedent studies and clinical guidelines. From March to July, 2011, a total of 23,704 clinic visits occurred at 98 shelters with 7934 residents. Oral antibiotics were prescribed a total of 2253 times. The median age of the patients was 48.5 years old (range 0-97), and 43.7% were male. Of 2253 antibiotic prescriptions, 1944 were judged to be inappropriate (86.3% 95% CI 84.8%-87.7%). The most prescribed antibiotic was clarithromycin (646 times, 28.7%), followed by cefcapene pivoxil (644 times, 28.6%), levofloxacin (380, 16.9%), cefdinir (194, 8.6%), and cefditren pivoxil (98, 4.4%). The most frequent diagnosis for which antibiotics were prescribed was upper respiratory infection (URI, 1040 visits, 46.2%), followed by acute bronchitis (369, 16.4%), pharyngitis (298, 13.2%), traumatic injuries (194, 8.6%), acute gastroenteritis (136, 6.0%), urinary tract infections (UTIs, 123, 5.5%), and allergic rhinitis (5.1%). The majority of antibiotics prescribed at clinics after the Great East Japan Earthquake was inappropriate. Significant improvement of the use of antibiotics in postdisaster settings should be sought immediately in Japan.
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Affiliation(s)
- Kentaro Iwata
- Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kobe
| | - Takahiko Fukuchi
- Department of General Medicine, Saitama Medical Center Jichi Medical University, Saitama
| | - Midori Hirai
- Department of Pharmacokinetics and Pharmaceutics, Kobe University Graduate School of Medicine, Kobe
| | - Kenichi Yoshimura
- Innovative Clinical Research Center (iCREK), Kanazawa University Hospital, Kanazawa
| | - Yasuhiro Kanatani
- Department of Health Crisis Management, National Institute of Public Health, Wako, Japan
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206
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Smith MJ, Gonzalez D, Goldman JL, Yogev R, Sullivan JE, Reed MD, Anand R, Martz K, Berezny K, Benjamin DK, Smith PB, Cohen-Wolkowiez M, Watt K. Pharmacokinetics of Clindamycin in Obese and Nonobese Children. Antimicrob Agents Chemother 2017; 61:e02014-16. [PMID: 28137820 PMCID: PMC5365720 DOI: 10.1128/aac.02014-16] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/12/2017] [Indexed: 12/12/2022] Open
Abstract
Although obesity is prevalent among children in the United States, pharmacokinetic (PK) data for obese children are limited. Clindamycin is a commonly used antibiotic that may require dose adjustment in obese children due to its lipophilic properties. We performed a clindamycin population PK analysis using data from three separate trials. A total of 420 samples from 220 children, 76 of whom had a body mass index greater than or equal to the 95th percentile for age, were included in the analysis. Compared to other metrics, total body weight (TBW) was the most robust measure of body size. The final model included TBW and a sigmoidal maturation relationship between postmenstrual age (PMA) and clearance (CL): CL (liters/hour) = 13.8 × (TBW/70)0.75 × [PMA2.83/(39.52.83+PMA2.83)]; volume of distribution (V) was associated with TBW, albumin (ALB), and alpha-1 acid glycoprotein (AAG): V (liters) = 63.6 × (TBW/70) × (ALB/3.3)-0.83 × (AAG/2.4)-0.25 After accounting for differences in TBW, obesity status did not explain additional interindividual variability in model parameters. Our findings support TBW-based dosing for obese and nonobese children.
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Affiliation(s)
- Michael J Smith
- Division of Pediatric Infectious Diseases, University of Louisville, Louisville, Kentucky, USA
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, Louisville, Kentucky, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Ram Yogev
- Northwestern University, Chicago, Illinois, USA
| | - Janice E Sullivan
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, Louisville, Kentucky, USA
| | | | | | | | - Katherine Berezny
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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207
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Brook I. The role of antibiotics in pediatric chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2017; 2:104-108. [PMID: 28894828 PMCID: PMC5527363 DOI: 10.1002/lio2.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/27/2016] [Accepted: 01/05/2017] [Indexed: 12/31/2022] Open
Abstract
Objectives Presenting the role of antibiotics in pediatric chronic rhinosinusitis based on its pathophysiology and microbiology. Data source Review of the literature searching PubMed for microbiology and treatment of pediatric chronic rhinosinusitis. Results Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that persists for 12 weeks or longer, despite medical management. The microbiology of rhinosinusitis evolves through several stages. The early phase (acute) is generally caused by a virus that may be followed by an aerobic bacterial infection in 2% to 10% of patients. Aerobic (Staphylococcus aureus) and anaerobic (Prevotella and Fusobacteria) members of the oral flora emerge as predominant sinus cavity isolates. Antimicrobials are one component of comprehensive medical and surgical management for this disorder. Because most of these infections are polymicrobial and many include beta‐lactamase producing aerobic and anaerobic organisms, amoxicillin‐clavulanate is the first‐line regimen for most patients. Clindamycin is adequate for penicillin‐allergic children and is also generally appropriate for methicillin resistant Staphylococcus aureus treatment is administered for at least three weeks and may be extended for up to 10 weeks in refractory cases. A culture preferably from the sinus cavity should be obtained from individuals who have not shown improvement or deteriorated despite therapy. Conclusions Antimicrobial therapy of pediatric chronic rhinosinusitis should be adequate against the potential aerobic and anaerobic pathogens. Level of Evidence 7.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics Georgetown University School of Medicine Washington D.C. U.S.A
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208
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Wintenberger C, Guery B, Bonnet E, Castan B, Cohen R, Diamantis S, Lesprit P, Maulin L, Péan Y, Peju E, Piroth L, Stahl JP, Strady C, Varon E, Vuotto F, Gauzit R. Proposal for shorter antibiotic therapies. Med Mal Infect 2017; 47:92-141. [PMID: 28279491 DOI: 10.1016/j.medmal.2017.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 01/30/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Reducing antibiotic consumption has now become a major public health priority. Reducing treatment duration is one of the means to achieve this objective. Guidelines on the therapeutic management of the most frequent infections recommend ranges of treatment duration in the ratio of one to two. The Recommendation Group of the French Infectious Diseases Society (SPILF) was asked to collect literature data to then recommend the shortest treatment durations possible for various infections. METHODS Analysis of the literature focused on guidelines published in French and English, supported by a systematic search on PubMed. Articles dating from one year before the guidelines publication to August 31, 2015 were searched on the website. RESULTS The shortest treatment durations based on the relevant clinical data were suggested for upper and lower respiratory tract infections, central venous catheter-related and uncomplicated primary bacteremia, infective endocarditis, bacterial meningitis, intra-abdominal, urinary tract, upper reproductive tract, bone and joint, skin and soft tissue infections, and febrile neutropenia. Details of analyzed articles were shown in tables. CONCLUSION This work stresses the need for new well-conducted studies evaluating treatment durations for some common infections. Following the above-mentioned work focusing on existing literature data, the Recommendation Group of the SPILF suggests specific study proposals.
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Affiliation(s)
- C Wintenberger
- Département de médecine interne, CHU de Grenoble Alpes, 38043 Grenoble, France
| | - B Guery
- Service de maladies infectieuses, CHU vaudois et université de Lausanne, Lausanne, Switzerland
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, hôpital Eugenie, boulevard Rossini, 20000 Ajaccio, France
| | - R Cohen
- IMRB-GRC GEMINI, unité Court Séjour, université Paris Est, Petits Nourrissons, centre hospitalier intercommunal de Créteil, ACTIV France, 40, avenue de Verdun, 94000 Créteil, France
| | - S Diamantis
- Service de maladies infectieuses et tropicales, centre hospitalier de Melun, 2, rue Fréteau-de-Peny, 77011 Melun cedex, France
| | - P Lesprit
- Infectiologie transversale, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - L Maulin
- Centre hospitalier du Pays-d'Aix, avenue de Tamaris, 13616 Aix-en-Provence, France
| | - Y Péan
- Observatoire national de l'épidémiologie de la résistance bactérienne aux antibiotiques (ONERBA), 10, rue de la Bonne-Aventure, 78000 Versailles, France
| | - E Peju
- Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - L Piroth
- Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - J P Stahl
- Infectiologie, université, CHU de Grenoble Alpes, 38043 Grenoble, France
| | - C Strady
- Cabinet d'infectiologie, clinique Saint-André, groupe Courlancy, 5, boulevard de la Paix, 51100 Reims, France
| | - E Varon
- Laboratoire de microbiologie, hôpital européen Georges-Pompidou, 75908 Paris cedex 15, France
| | - F Vuotto
- Service de maladies infectieuses, CHU vaudois et université de Lausanne, Lausanne, Switzerland
| | - R Gauzit
- Réanimation et infectiologie transversale, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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209
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Ushkalova EA, Zyryanov SK, Shvarts GY. [The use of intranasal glucocorticosteroids in the treatment of rhinosinusitis: Focus on mometasone furoate]. Vestn Otorinolaringol 2017; 81:59-66. [PMID: 27876741 DOI: 10.17116/otorino201681559-66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors discuss the mechanism of action, effectiveness, and safety of intranasal glucocorticosteroids (inGCS) used to treat acute, recurrent and chronic rhinosinusitis (RS). The last version of the European guidelines concerning the application of inGCS assigns the highest level of evidence-Ia and the highest strength of recommendations-A to these medications when applied for the treatment of acute and polypoid rhinosinusitis. Moreover, they acquire the status of the agents of choice for the therapy of chronic RS without polyps. Mometasone furoate is one of the best explored preparations of this group of medicines. It is possessed of favourable pharmacodynamic and pharmacokinetic properties when prescribed for local application. The new mometasone furoate preparation in the form of an intranasal spray Dezrinit produced by "Teva" Ltd. was registered in the Russian Federation. In a comparative randomized clinical trial (RCT), the preparation was shown to be an equivalent to the Nasonex spray.
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Affiliation(s)
- E A Ushkalova
- Russian University of People's Friendship, Moscow, Russia, 117198
| | - S K Zyryanov
- Russian University of People's Friendship, Moscow, Russia, 117198
| | - G Ya Shvarts
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 11999; 'Teva' Ltd., Moscow, Russia, 115054
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210
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Diagnose und Therapie von Atemwegsinfektionen (ohne ambulant erworbene Pneumonie) bei ambulant behandelten Kindern ohne schwerwiegende Grunderkrankung. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0257-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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211
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Libman H, Brockmeyer DM, Gold HS. Should We Prescribe Antibiotics to This Patient With Persistent Upper Respiratory Symptoms?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2017; 166:201-208. [PMID: 28166559 DOI: 10.7326/m16-2766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) recently published advice for high-value care on the appropriate use of antibiotics for acute respiratory tract infections. They conducted a narrative literature review of evidence for antibiotic use in this setting that included recent clinical guidelines from professional societies supplemented by randomized, controlled trials; meta-analyses; and systematic reviews. They concluded that clinicians should reserve antibiotic treatment for acute rhinosinusitis in patients with persistent symptoms for more than 10 days, high fever and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or worsening symptoms after a typical viral illness that lasted 5 days and had initially improved ("double-sickening"). In this Grand Rounds, 2 prominent clinicians debate whether to initiate antibiotic treatment in a 62-year-old man with a history of recurrent sinusitis who presents with persistent upper respiratory symptoms. They review the data on which the ACP/CDC recommendations are based and discuss the potential benefits and risks, as well as the challenges and controversies, of prescribing antibiotic therapy in this setting.
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212
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Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, Park DY, Kim HJ, Kim DY, Lee HJ, Shin HY, You YK, Park DA, Kim SW. Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother 2017; 49:326-352. [PMID: 29299900 PMCID: PMC5754344 DOI: 10.3947/ic.2017.49.4.326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 12/20/2022] Open
Abstract
These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
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Affiliation(s)
- Young Kyung Yoon
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chan Soon Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Wook Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Kyurin Hwang
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Sei Young Lee
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Do Yang Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Hyun Jun Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Dong Young Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Hyun Jong Lee
- Korean Association of Otorhinolaryngologists, Seoul, Korea
| | - Hyun Young Shin
- Korean Association of Family Medicine, Seoul, Korea.,Department of Family Medicine, Myongji Hospital, Seonam University, College of Medicine, Goyang, Korea
| | - Yong Kyu You
- Korean Medical Practitioners Association, Seoul, Korea.,Department of Internal Medicine, Nammoon Medical Clinic, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Shin Woo Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Korean Society for Chemotherapy, Seoul, Korea.,Department of Internal Medicine, Kungpook National University, School of Medicine, Daegu, Korea.
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213
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Rhinosinusitis and Tonsillopharyngitis. Fam Med 2017. [PMCID: PMC7121430 DOI: 10.1007/978-3-319-04414-9_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sinusitis is characterized by mucosal inflammation of the sinuses which is almost always accompanied by inflammation of the nasal passages. Since nasal mucosa is contiguous with paranasal sinus mucosa, the term sinusitis is often used interchangeably with [1]; the latter term will be used in this chapter. Rhinosinusitis can be acute (less than 4 weeks’ duration), subacute (4–12 weeks), or chronic (greater than 12 weeks) [2].
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214
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Guibas GV, Papadopoulos NG. Viral Upper Respiratory Tract Infections. VIRAL INFECTIONS IN CHILDREN, VOLUME II 2017. [PMCID: PMC7121526 DOI: 10.1007/978-3-319-54093-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The upper respiratory system is one of the most common sites of infection for adults, but even more so for children. Several viruses, from variable families, cause upper respiratory infections which, although generally underestimated due to their typically self-limiting nature, underlie enormous healthcare resource utilization and financial burden. Such, otherwise “benign” infections, can have very significant sequelae both in the form of bringing about local complications but also inducing asthma attacks, thus greatly increasing morbidity. Their enormous prevalence also indicates that rigorous research should be undertaken in order to tackle them, in both the prevention and treatment field.
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215
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Al Mohajer M, Matthias KR, Nix DE. Improving the knowledge of students and physicians regarding appropriate use of antibiotics for respiratory infections through an online educational module. Am J Infect Control 2017; 45:e15-e17. [PMID: 27839751 DOI: 10.1016/j.ajic.2016.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Abstract
We developed an interactive online module to improve the knowledge of students and physicians regarding respiratory infections. Our study showed that the completion of this module was associated with substantial improvement in knowledge, with modest retention after 2 months.
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216
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Paulman PM, Taylor RB, Paulman AA, Nasir LS. Infectious Diseases of Children. Fam Med 2017. [PMCID: PMC7189426 DOI: 10.1007/978-3-319-04414-9_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Infections are the most common cause of acute illness in children. Most commonly these are respiratory infections which peak when the child starts to go to school or out-of-home day care. Although the majority of these diseases have benign course, they cause significant discomfort, anxiety, missed work, and stress to many families caring for children. Frequent office visits, and unnecessarily prescribed medications, and sometimes dubious home remedies can be reduced by following best evidence-based practice and having a good doctor-patient (and parent) relationship.
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Affiliation(s)
- Paul M. Paulman
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska USA
| | - Robert B. Taylor
- Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia USA
| | - Audrey A. Paulman
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska USA
| | - Laeth S. Nasir
- Department of Family Medicine, Creighton University School of Medicine, Omaha, Nebraska USA
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217
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Dippold N, Klimek L. [Rhinosinusitis - diagnosis and guideline-based therapy]. MMW Fortschr Med 2017; 159:37-43. [PMID: 28097556 DOI: 10.1007/s15006-017-9158-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Nina Dippold
- Zentrum für Rhinologie und Allergologie, An den Quellen 10, D-65183, Wiesbaden, Deutschland
| | - Ludger Klimek
- Zentrum für Rhinologie und Allergologie, An den Quellen 10, D-65183, Wiesbaden, Deutschland.
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218
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Cough, Cold, and Congestion. PRIMARY CARE FOR EMERGENCY PHYSICIANS 2017. [PMCID: PMC7121044 DOI: 10.1007/978-3-319-44360-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The common cold is a benign, self-limited, acute viral infection with associated symptoms of sneezing, rhinorrhea, nasal congestion, cough, and malaise. It is the most frequent acute illness in the industrialized world. Adults typically have two to three episodes of illness yearly while children can have up to five. The common cold is typically caused by viruses (including rhinovirus, RSV, coronavirus, and others), and often, no infecting organism is detected. Treatment is usually targeted at symptomatic relief. The differential diagnosis for cough, cold, and congestion is broad: ranging from non-emergent causes such as rhinitis to life-threatening illnesses such as pulmonary embolism. Careful assessment is necessary as misidentification can lead to inappropriate discharge of potentially lethal conditions.
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Torumkuney D, Gur D, Soyletir G, Gurler N, Aktas Z, Sener B, Tunger A, Bayramoglu G, Koksal I, Yalcin AN, Tanriver Y, Morrissey I, Barker K. Results from the Survey of Antibiotic Resistance (SOAR) 2002-09 in Turkey. J Antimicrob Chemother 2016; 71 Suppl 1:i85-91. [PMID: 27048585 DOI: 10.1093/jac/dkw067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate changes in antibiotic susceptibility of Streptococcus pneumoniae and Haemophilus influenzae from the Survey of Antibiotic Resistance (SOAR) in community-acquired respiratory tract infections (CA-RTIs) between 2002 and 2009 in Turkey. METHODS Previously published SOAR data were used for this analysis. MICs were determined using Etest(®) gradient strips or disc diffusion. Susceptibility against a range of antimicrobial agents was assessed using CLSI breakpoints. RESULTS A total of 900 S. pneumoniae isolates were analysed: 2002-03 (n = 75), 2004-05 (n = 301) and 2007-09 (n = 524). Four antibiotics were tested consistently throughout and three showed a statistically significant decrease in susceptibility (P < 0.0001): penicillin (74.7% susceptible in 2002-03; 67.8% in 2004-05; and 47.2% in 2007-09); cefaclor (85.3% in 2002-03; 78.7% in 2004-05; and 53.5% in 2007-09) and clarithromycin (85.3% in 2002-03; 82.7% in 2004-05; and 61.9% in 2007-09). Susceptibility to amoxicillin/clavulanic acid did not significantly change (100% in 2002-03; 98.7% in 2004-05; and 97.7% in 2007-09). A total of 930 H. influenzae isolates were analysed: 2002-03 (n = 133), 2004-05 (n = 379) and 2007-09 (n = 418). Four antibiotics were also consistently tested: ampicillin, amoxicillin/clavulanic acid, clarithromycin and cefaclor. All showed >90% susceptibility, but only cefaclor susceptibility significantly reduced (P < 0.0001) over time (99.2% in 2002-03; 96.3% in 2004-05; and 90.4% in 2007-09). CONCLUSIONS In S. pneumoniae from Turkey, there has been a clear statistically significant reduction in susceptibility to key antibiotics since 2002, but not to amoxicillin/clavulanic acid (or amoxicillin). However, susceptibility in H. influenzae remained stable. Continued surveillance is required to monitor future changes in antibiotic susceptibility for CA-RTI bacteria.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - D Gur
- Hacettepe University Medical Faculty, Department of Medical Microbiology, Ankara, Turkey
| | - G Soyletir
- Marmara University Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - N Gurler
- Istanbul University, Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Z Aktas
- Istanbul University, Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - B Sener
- Hacettepe University Medical Faculty, Department of Medical Microbiology, Ankara, Turkey
| | - A Tunger
- Ege University Medical Faculty, Department of Medical Microbiology, Izmir, Turkey
| | - G Bayramoglu
- Karadeniz Technical University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - I Koksal
- Karadeniz Technical University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - A N Yalcin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Y Tanriver
- GlaxoSmithKline Turkey, Buyukdere Cad. 1. Levent Plaza, No. 173, B Blok, 34394 Istanbul, Turkey
| | - I Morrissey
- IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland
| | - K Barker
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
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220
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Chua KP, Schwartz AL, Volerman A, Conti RM, Huang ES. Use of Low-Value Pediatric Services Among the Commercially Insured. Pediatrics 2016; 138:e20161809. [PMID: 27940698 PMCID: PMC5127068 DOI: 10.1542/peds.2016-1809] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Claims-based measures of "low-value" pediatric services could facilitate the implementation of interventions to reduce the provision of potentially harmful services to children. However, few such measures have been developed. METHODS We developed claims-based measures of 20 services that typically do not improve child health according to evidence-based guidelines (eg, cough and cold medicines). Using these measures and claims from 4.4 million commercially insured US children in the 2014 Truven MarketScan Commercial Claims and Encounters database, we calculated the proportion of children who received at least 1 low-value pediatric service during the year, as well as total and out-of-pocket spending on these services. We report estimates based on "narrow" measures designed to only capture instances of service use that were low-value. To assess the sensitivity of results to measure specification, we also reported estimates based on "broad measures" designed to capture most instances of service use that were low-value. RESULTS According to the narrow measures, 9.6% of children in our sample received at least 1 of the 20 low-value services during the year, resulting in $27.0 million in spending, of which $9.2 million was paid out-of-pocket (33.9%). According to the broad measures, 14.0% of children in our sample received at least 1 of the 20 low-value services during the year. CONCLUSIONS According to a novel set of claims-based measures, at least 1 in 10 children in our sample received low-value pediatric services during 2014. Estimates of low-value pediatric service use may vary substantially with measure specification.
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Affiliation(s)
- Kao-Ping Chua
- Sections of Academic Pediatrics, and
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois; and
| | | | - Anna Volerman
- Sections of Academic Pediatrics, and
- Section of General Internal Medicine, Department of Medicine, and
| | - Rena M Conti
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois; and
- Pediatric Hematology/Oncology, Department of Pediatrics
| | - Elbert S Huang
- Section of General Internal Medicine, Department of Medicine, and
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221
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Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep 2016; 65:1-12. [PMID: 27832047 DOI: 10.15585/mmwr.rr6506a1] [Citation(s) in RCA: 361] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management. The four core elements of outpatient antibiotic stewardship are commitment, action for policy and practice, tracking and reporting, and education and expertise. Outpatient clinicians and facility leaders can commit to improving antibiotic prescribing and take action by implementing at least one policy or practice aimed at improving antibiotic prescribing practices. Clinicians and leaders of outpatient clinics and health care systems can track antibiotic prescribing practices and regularly report these data back to clinicians. Clinicians can provide educational resources to patients and families on appropriate antibiotic use. Finally, leaders of outpatient clinics and health systems can provide clinicians with education aimed at improving antibiotic prescribing and with access to persons with expertise in antibiotic stewardship. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient health care settings.
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222
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Autio TJ, Koskenkorva T, Leino TK, Koivunen P, Alho OP. Longitudinal analysis of inflammatory biomarkers during acute rhinosinusitis. Laryngoscope 2016; 127:E55-E61. [PMID: 27753120 PMCID: PMC7165676 DOI: 10.1002/lary.26344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/15/2016] [Accepted: 09/01/2016] [Indexed: 11/16/2022]
Abstract
Objective To illuminate the pathophysiology of acute rhinosinusitis (ARS) with sequential monitoring of inflammatory biomarkers during an ARS episode and to clarify their diagnostic usability in bacterial ARS. Study Design Inception cohort study with 50 conscripts with ARS. Methods We collected peripheral blood high‐sensitive C‐reactive protein (hs‐CRP), white blood cell (WBC), procalcitonin, and nasal nitric oxide (nNO) counts at 2 to 3 and 9 to 10 days of symptoms during an ARS episode. We simultaneously gathered various clinical parameters and microbiological samples. Bacterial ARS was confirmed with a positive culture of sinus aspirate. Results Reciprocal correlations and a significant change in biomarker levels between the two visits suggest that ARS involves a local and systemic inflammatory response that was strongest at 2 to 3 days. High‐sensitive CRP and nNO reflected responses best (52% had increased CRP levels at 2–3 days; 66% had decreased nNO levels). White blood cell and procalcitonin counts rarely exceeded the reference range. Increased local and systemic inflammatory response were linked to multiple, adenoviral, or influenza A viral etiology or the detection of bacterial ARS. Local response correlated with imaging findings of wide paranasal sinus involvement and ostiomeatal complex occlusion. At 9 to 10 days, elevated (≥ 11 mg/L) and moderately elevated (≥ 49 mg/L) hs‐CRP predicted bacterial ARS well (likelihood ratio [LR]+ 3.3 and LR+ 15.8, respectively), but the sensitivity for both findings remained low. Conclusion Acute rhinosinusitis (particularly bacterial ARS) involves a local and systemic inflammatory response that is strongest at the beginning of symptoms. Elevated hs‐CRP supports the diagnosis of bacterial ARS. Level of Evidence 4. Laryngoscope, 2016 127:E55–E61, 2017
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Affiliation(s)
- Timo J Autio
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu
| | - Timo Koskenkorva
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu
| | - Tuomo K Leino
- Air Force Command Finland, Finnish Defense Forces, Tikkakoski, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu
| | - Olli-Pekka Alho
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu
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223
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Tatar A, Korkmaz M, Yayla M, Polat E, Uslu H, Halici Z, Parlak SN. The potential role of amlodipine on experimentally induced bacterial rhinosinusitis. Braz J Otorhinolaryngol 2016; 83:619-626. [PMID: 27769794 PMCID: PMC9449041 DOI: 10.1016/j.bjorl.2016.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 07/24/2016] [Accepted: 08/09/2016] [Indexed: 01/29/2023] Open
Abstract
Introduction Antibiotics are frequently used for the treatment of rhinosinusitis. Concerns have been raised regarding the adverse effects of antibiotics and growing resistance. The lack of development of new antibiotic compounds has increased the necessity for exploration of non-antibiotic compounds that have antibacterial activity. Amlodipine is a non-antibiotic compound with anti-inflammatory activity. Objective In this study we aimed to investigate the potential role of amlodipine in the treatment of rhinosinusitis by evaluating its effects on tissue oxidative status, mucosal histology and inflammation. Methods Fifteen adult albino guinea pigs were inoculated with Staphylococcus aureus and treated with saline, cefazolin sodium, or amlodipine for 7 days. The control group was composed by five healthy guinea pigs. Animals were sacrificed after the treatment. Histopathological changes were identified using Hematoxylin-Eosin staining. Inflammation was assessed by Polymorphonuclear Leukocyte infiltration density. Tissue levels of antioxidants (superoxide dismutase, glutathione) and an oxidative product (malondialdehyde) were determined. Results In rhinosinusitis induced animals, amlodipine reduced loss of cilia, lamina propria edema and collagen deposition compared to placebo (saline) and although not superior to cefazolin, amlodipine decreased polymorphonuclear leukocyte infiltration. The superoxide dismutase activity and glutathione levels were reduced, whereas the malondialdehyde levels were increased significantly in all three-treatment groups compared to the control group. Amlodipine treated group showed significantly increased superoxide dismutase and glutathione levels and decreased malondialdehyde levels compared to all treatment groups. Conclusion The non-antibiotic compound amlodipine may have a role in acute rhinosinusitis treatment through tissue protective, antioxidant and anti-inflammatory mechanisms.
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Affiliation(s)
- Arzu Tatar
- Ataturk University, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Erzurum, Turkey.
| | - Mukadder Korkmaz
- Ordu University, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Ordu, Turkey
| | - Muhammed Yayla
- Kafkas University, Medical Faculty, Department of Pharmacology, Kars, Turkey
| | - Elif Polat
- Ataturk University, Medical Faculty, Department of Embryology and Histology, Erzurum, Turkey
| | - Hakan Uslu
- Ataturk University, Medical Faculty, Department of Medical Microbiology, Erzurum, Turkey
| | - Zekai Halici
- Ataturk University, Medical Faculty, Department of Pharmacology, Erzurum, Turkey
| | - Secil N Parlak
- Ataturk University, Medical Faculty, Department of Embryology and Histology, Erzurum, Turkey
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224
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Affiliation(s)
- Richard M Rosenfeld
- From the Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
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225
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Patel K, Goldman JL. Safety Concerns Surrounding Quinolone Use in Children. J Clin Pharmacol 2016; 56:1060-75. [PMID: 26865283 PMCID: PMC4994191 DOI: 10.1002/jcph.715] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 02/02/2023]
Abstract
Fluoroquinolones are highly effective antibiotics with many desirable pharmacokinetic and pharmacodynamic properties including high bioavailability, large volume of distribution, and a broad spectrum of antimicrobial activity. Despite their attractive profile as anti-infective agents, their use in children is limited, primarily due to safety concerns. In this review we highlight the pharmacological properties of fluoroquinolones and describe their current use in pediatrics. In addition, we provide a comprehensive assessment of the safety data associated with fluoroquinolone use in children. Although permanent or destructive arthropathy remains a significant concern, currently available data demonstrate that arthralgia and arthropathy are relatively uncommon in children and resolve following cessation of fluoroquinolone exposure without resulting in long-term sequelae. The concern for safety and risk of adverse events associated with pediatric fluoroquinolone use is likely driving the limited prescribing of this drug class in pediatrics. However, in adults, fluoroquinolones are the most commonly prescribed broad-spectrum antibiotics, resulting in the development of drug-resistant bacteria that can be challenging to treat effectively. The consequence of misuse and overuse of fluoroquinolones leading to drug resistance is a greater, but frequently overlooked, safety concern that applies to both children and adults and one that should be considered at the point of prescribing.
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Affiliation(s)
- Karisma Patel
- Department of Pharmacy, Children’s Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
- Divisions of Pediatric Infectious Diseases, Children’s Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jennifer L. Goldman
- Department of Pediatrics, Children’s Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
- Divisions of Pediatric Infectious Diseases, Children’s Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
- Clinical Pharmacology, Children’s Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
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226
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What Drives Variation in Antibiotic Prescribing for Acute Respiratory Infections? J Gen Intern Med 2016; 31:918-24. [PMID: 27067351 PMCID: PMC4945551 DOI: 10.1007/s11606-016-3643-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/30/2015] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute respiratory infections are the most common symptomatic reason for seeking care among patients in the US, and account for the majority of all antibiotic prescribing, yet a large fraction of antibiotic prescriptions are inappropriate. OBJECTIVE We sought to identify the underlying factors driving variation in antibiotic prescribing across clinicians and settings. DESIGN, PARTICIPANTS Using electronic health data for adult ambulatory visits for acute respiratory infections to a retail clinic chain and primary care practices from an integrated healthcare system, we identified a random sample of clinicians for survey. MAIN MEASURES We evaluated independent predictors of overall prescribing and imperfect antibiotic prescribing, controlling for clinician and site of care. We defined imperfect antibiotic prescribing as prescribing for non-antibiotic-appropriate diagnoses, failure to prescribe for an antibiotic-appropriate diagnosis, or prescribing a non-guideline-concordant antibiotic. KEY RESULTS Response rates were 34 % for retail clinics and 24 % for physicians' offices (N = 187). Clinicians in physicians' offices prescribed antibiotics less often than those in retail clinics (53 % versus 67 %; p < 0.01), but had a higher imperfect antibiotic prescribing rate (65 % versus 31 %; p < 0.01). Feeling rushed was associated with higher antibiotic prescribing (OR 1.34; 95 % CI 1.03, 1.75). Antibiotic prescribing was also associated with clinician disagreement that antibiotics are overused (OR 1.60, 95 % CI, 1.16, 2.20). Imperfect antibiotic prescribing was associated with receiving antibiotic prescribing feedback (OR 1.35, 95 % CI 1.04, 1.75) and disagreement that patient demand was a problem (OR 1.66, 95 % CI 1.00, 2.73). Imperfect antibiotic prescribing was less common with clinicians who perceived that they prescribed antibiotics less often than their peers (OR 0.63, 95 % CI 0.46, 0.87). CONCLUSIONS Poor-quality antibiotic prescribing was associated with feeling rushed, believing less strongly that antibiotics were overused, and believing that patient demand was not an issue, factors that can be assessed and addressed in future interventions.
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227
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Beam C, Fuss J, Stoelting-Gettelfinger W. A Comprehensive Review of Common Respiratory Infections Encountered in Urgent and Primary Care: A Reference Guide for Judicious Antibiotic Use with Complementary Therapies. J Emerg Nurs 2016; 42:376-86. [PMID: 27452150 DOI: 10.1016/j.jen.2016.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/26/2016] [Accepted: 02/06/2016] [Indexed: 10/21/2022]
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Abstract
Rhinosinusitis, is defined as an inflammation of the paranasal and nasal sinus mucosae. Chronic rhinosinusitis (CRS)is a common problem in the pediatric age group and the diagnosis and treatment are challenging due to the chronicity and similarity of symptoms with allergic rhinitis and adenoid hypertrophy. Although it is less common than acute rhinosinusitis, CRS is becoming more frequent and significantly affects the quality of life in children and can substantially impair daily function. CRS is characterized by sinus symptoms lasting more than 3 months despite medical therapy. Many factors are involved in the pathogenesis of this disease and include a primary insult with a virus followed bybacterial infection and mucosal inflammation, along with predisposition to allergies. The standard treatment of pediatricacute bacterial rhinosinusitis (ABRS) is nasal irrigation and antibiotic use. Medical treatment of pediatric CRS includes avoidance of allergens in allergic patients (environmental or food) and therapy with nasal irrigation, nasal corticosteroids sprays, nasal decongestants, and antibiotics directed at the most common sinonasalorganisms (Haemophilusinfluenzae, Streptococcus pneumoniae, and Moraxella catarrhalis). Surgical therapy is rarely needed after appropriate medical therapy. Referral to an otolaryngologist and allergy specialist is recommended in case of failure of medical treatment.
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Previous Antibiotic Exposure Increases Risk of Infection with Extended-Spectrum-β-Lactamase- and AmpC-Producing Escherichia coli and Klebsiella pneumoniae in Pediatric Patients. Antimicrob Agents Chemother 2016; 60:4237-43. [PMID: 27139486 DOI: 10.1128/aac.00187-16] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/27/2016] [Indexed: 12/24/2022] Open
Abstract
The objective of this study was to determine whether antibiotic exposure is associated with extended-spectrum-beta-lactamase- or AmpC-producing Escherichia coli or Klebsiella pneumoniae infections in children. We collected extended-spectrum-beta-lactamase- or AmpC-producing E. coli or K. pneumoniae isolates and same-species susceptible controls from normally sterile sites of patients aged ≤21 years, along with associated clinical data, at four free-standing pediatric centers. After controlling for potential confounders, the relative risk of having an extended-spectrum-beta-lactamase-producing isolate rather than a susceptible isolate was 2.2 times higher (95% confidence interval [CI], 1.49 to 3.35) among those with antibiotic exposure in the 30 days prior to infection than in those with no antibiotic exposure. The results were similar when analyses were limited to exposure to third-generation cephalosporins, other broad-spectrum beta-lactams, or trimethoprim-sulfamethoxazole. Conversely, the relative risk of having an AmpC-producing versus a susceptible isolate was not significantly elevated with any antibiotic exposure in the 30 days prior to infection (adjusted relative risk ratio, 1.12; 95% CI, 0.65 to 1.91). However, when examining subgroups of antibiotics, the relative risk of having an AmpC-producing isolate was higher for patients with exposure to third-generation cephalosporins (adjusted relative risk ratio, 4.48; 95% CI, 1.75 to 11.43). Dose-response relationships between antibiotic exposure and extended-spectrum-beta-lactamase-producing or AmpC-producing isolates were not demonstrated. These results reinforce the need to study and implement pediatric antimicrobial stewardship strategies, and they indicate that epidemiological studies of third-generation cephalosporin-resistant E. coli and K. pneumoniae isolates should include resistance mechanisms when possible.
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Abstract
Diagnostic imaging is the most rapidly growing physician service in the Medicare and privately insured population. The growing share of medical costs devoted to imaging procedures has led to increasing concerns among the key federal agencies and private payers. In an attempt to educate health care providers, patients, and families on the importance of making optimal clinical decisions, the American Board of Internal Medicine Foundation organized the Choosing Wisely initiative with strong collaboration from specialty societies representing nearly all medical disciplines. Among 45 tests and treatments listed on the Choosing Wisely Web site, 24 are directly related to imaging. Eleven of the 24 are associated with neuroimaging. The listing of imaging tests in the Choosing Wisely program by multiple medical societies other than the radiology societies acknowledges that appropriate use of medical imaging is a shared responsibility between radiologists and referring physicians. In this article, we highlight why radiologists are uniquely positioned to support the appropriate use of imaging. We review some of the strategies that radiologists can use to help their referring physicians with appropriate ordering of neuroimaging in real-world practice and address some the challenges and pitfalls in implementing patient-centered imaging decision-making and shifting to a value-based focus in radiology.
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Affiliation(s)
- J Buethe
- From the Department of Radiology (J.B.), Johns Hopkins Hospital, Baltimore, Maryland
| | - J Nazarian
- Department of Neuroradiology (J.N.), Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - K Kalisz
- Department of Radiology (K.K.), University Hospitals Case Medical Center Case Western Reserve University, Cleveland, Ohio
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Section, Stanford University School of Medicine, Stanford, California.
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231
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Abstract
BACKGROUND Acute respiratory infections (ARIs) are the most common symptomatic reason to seek ambulatory care, but many ARI visits may not be necessary. OBJECTIVE To measure the proportion of primary care ARI visits that may not require an office visit. METHODS We identified 58398 ARI visits to 14 primary care practices between May 2011 and May 2012 and randomly selected 500 visits, 439 of which were new ARI visits. We separated non-visit-required information [e.g. history of present illness (HPI), past medical history, etc.] from information that required an office visit (e.g. physical exam, testing, etc.). Reviewing non-visit-required information, we identified the diagnosis (HPI diagnosis) and whether office visit appeared necessary. Independently, we reviewed the visit-required information and determined if the visit changed antibiotic management. RESULTS Based on non-visit-required information, 72% (316/439) of visits did not appear to require an office visit. The most common diagnoses were non-specific upper respiratory infection (39%), sinusitis (24%) and acute bronchitis (22%). The HPI diagnosis was an exact match for clinicians' diagnosis in 67% (213/316) of visits. After reviewing the visit-required information, antibiotic management did not change for 87% (276/316) of visits. For the remaining 13% (40/316) for which the visit changed management, the clinician prescribed an antibiotic for an antibiotic-appropriate diagnosis (65%; 26/40); prescribed an antibiotic for a non-antibiotic-appropriate diagnosis (25%; 10/40); or avoided an antibiotic prescription for patients with an HPI diagnosis of sinusitis (10%; 4/40). CONCLUSION About two-thirds of primary care ARI visits may not be necessary for appropriate antibiotic management.
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Affiliation(s)
- Sruthi Renati
- Transitional Year Program, Beaumont Hospital, Dearborn, MI
| | - Jeffrey A Linder
- Harvard Medical School and Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
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Sanchez GV, Roberts RM, Albert AP, Johnson DD, Hicks LA. Effects of knowledge, attitudes, and practices of primary care providers on antibiotic selection, United States. Emerg Infect Dis 2016; 20:2041-7. [PMID: 25418868 PMCID: PMC4257826 DOI: 10.3201/eid2012.140331] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary care providers were familiar with recommendations for antibiotic drug selection for common infections, but do not always comply with them. Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for common infections. Participants were generally familiar with guideline recommendations for antibiotic drug selection for common infections, but did not always comply with them. Reasons for nonadherence included the belief that nonrecommended agents are more likely to cure an infection, concern for patient or parent satisfaction, and fear of infectious complications. Providers inconsistently defined broad- and narrow-spectrum antibiotic agents. There was widespread concern for antibiotic resistance; however, it was not commonly considered when selecting therapy. Strategies to encourage use of first-line agents are needed in addition to limiting unnecessary prescribing of antibiotic drugs.
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233
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Smith KL, Tran D, Westra BL. Sinusitis Treatment Guideline Adherence in the E-Visit Setting: A Performance Improvement Project. Appl Clin Inform 2016; 7:299-307. [PMID: 27437042 DOI: 10.4338/aci-2015-10-cr-0143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Studies demonstrate poor guideline adherence by health care providers for the treatment of upper respiratory infections, particularly acute bacterial rhinosinusitis (ABRS), in the appropriate prescribing of antibiotic medications. OBJECTIVE The purpose of this quality improvement project was to evaluate the effect of implementing interventions for improving adherence to a clinical practice guideline for the management of ABRS for patients treated in the e-visit setting. Interventions included: providing a report to providers of their adherence to the ABRS clinical guideline prior to the intervention, providing updated education on the ABRS guideline, and implementing a clinical decision support system reminder. METHODS A pre and post intervention evaluation design was used. Data were obtained from a retrospective electronic health record (EHR) data extract of all 316 diagnoses for ABRS in the pre-intervention 2-month time period and all 368 diagnoses of ABRS in the post-intervention 2-month time period. A review of the structured clinical data elements was performed to determine whether the provider adhered to the clinical guideline, meaning that only patients meeting the criteria for ABRS were to receive an antibiotic prescription. RESULTS AND CONCLUSION The interventions resulted in a 3.3% improvement in adherence to the ABRS clinical guideline from 95.25% adherence pre-intervention to 98.4% post-intervention. These results demonstrated that the use of an educational intervention and clinical decision support resulted in improved adherence to the ABRS clinical guideline in the e-visit setting. The implications for practice could be significant in that these quality improvement interventions improve guideline adherence and reduce unnecessary prescribing of antibiotics.
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Affiliation(s)
| | - Dang Tran
- Fairview Health System , Minneapolis, Minnesota, United States
| | - Bonnie L Westra
- University of Minnesota, School of Nursing , Minneapolis, Minnesota, United States
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234
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Abstracts from The American Telemedicine Association 2016 Annual Meeting and Trade Show. Telemed J E Health 2016; 22:A1-A102. [DOI: 10.1089/tmj.2016.29004-a.abstracts] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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235
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Gidengil CA, Linder JA, Beach S, Setodji CM, Hunter G, Mehrotra A. Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2016; 53:0046958016636531. [PMID: 27098876 PMCID: PMC4840477 DOI: 10.1177/0046958016636531] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 11/17/2022]
Abstract
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. Our objective was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. We surveyed physicians (n = 78) and retail clinic clinicians (n = 109) between January and September 2013. We surveyed clinicians using a set of ARI vignettes and linked the responses to electronic health record data for all ARI visits managed by these clinicians during 2012. We then created a new measure of antibiotic prescribing, the comprehensive ARI management rate. This was defined as not prescribing antibiotics for antibiotic-inappropriate diagnoses and prescribing guideline-concordant antibiotics for antibiotic-appropriate diagnoses (and also included appropriate use of streptococcal testing for the pharyngitis vignettes). We compared the vignette-based and chart-based comprehensive ARI management at the clinician level. We then identified the combination of vignettes that best predicted comprehensive ARI management rates, using a partitioning algorithm. Responses to 3 vignettes partitioned clinicians into 4 groups with chart-based comprehensive ARI management rates of 61% (n = 121), 50% (n = 47), 31% (n = 12), and 22% (n = 7). Responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
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Affiliation(s)
- Courtney A Gidengil
- RAND Corporation, Boston, MA, USA Boston Children's Hospital, Boston, MA Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Linder
- Brigham and Women's Hospital, Boston, MA University of Pittsburgh, PA, USA
| | | | | | | | - Ateev Mehrotra
- RAND Corporation, Boston, MA, USA Harvard Medical School, Boston, MA, USA Beth Israel Deaconess Medical Center, Boston, MA, USA
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Monedero Mira MJ, Sales MB, Domingo CG, Monedero Mira MJ, Saura BP, Mallen GR, Porcar LT. Tratamiento empírico de las infecciones del adulto. FMC : FORMACION MEDICA CONTINUADA EN ATENCION PRIMARIA 2016; 23:9-71. [PMID: 32288498 PMCID: PMC7144499 DOI: 10.1016/j.fmc.2015.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 12/12/2022]
Affiliation(s)
- María José Monedero Mira
- Médico especialista en Medicina Familiar y Comunitaria, CS Rafalafena, Castellón. Profesor asociado de Medicina, Facultad de Ciencias de la Salud, Universitat Jaume I, Castellón, España
| | - Manuel Batalla Sales
- Médico especialista en Medicina Familiar y Comunitaria, CS Rafalafena, Castellón. Profesor asociado de Medicina, Facultad de Ciencias de la Salud, Universitat Jaume I, Castellón, España
| | | | - María José Monedero Mira
- Médico especialista en Medicina Familiar y Comunitaria, CS Rafalafena, Castellón. Profesor asociado de Medicina, Facultad de Ciencias de la Salud, Universitat Jaume I, Castellón, España
| | - Belén Persiva Saura
- Médico especialista en Medicina Familiar y Comunitaria, CS Rafalafena, Castellón, España
| | | | - Lledó Tárrega Porcar
- Médico especialista en Medicina Familiar y Comunitaria, CS Rafalafena, Castellón, España
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237
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Scangas GA, Su BM, Remenschneider AK, Shrime MG, Metson R. Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 6:582-9. [DOI: 10.1002/alr.21697] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 12/28/2022]
Affiliation(s)
- George A. Scangas
- Department of Otology and Laryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston MA
| | - Brooke M. Su
- School of Medicine; University of California, San Francisco; San Francisco CA
| | - Aaron K. Remenschneider
- Department of Otology and Laryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston MA
| | - Mark G. Shrime
- Department of Otology and Laryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston MA
- Program in Global Surgery and Social Change; Harvard Medical School; Boston MA
| | - Ralph Metson
- Department of Otology and Laryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston MA
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238
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Benninger MS, Holy CE, Trask DK. Acute Rhinosinusitis: Prescription Patterns in a Real-World Setting. Otolaryngol Head Neck Surg 2016; 154:957-62. [PMID: 26932952 DOI: 10.1177/0194599816630310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/12/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Understand real-world prescription patterns for patients presenting with a first diagnosis of ARS and evaluate adherence to published medical guidelines. STUDY DESIGN Retrospective administrative database analysis. SETTING US-based outpatient settings. METHODS From a US claims database (MarketScan), 99,033 patients were identified with acute rhinosinusitis (ARS) in 2012 ("index"), with a complete medical and prescription history for 12 months preindex and 18 months postindex and no diagnoses of asthma or chronic rhinosinusitis. Of these, a random 10,000-patient sample was generated matched for age and sex to the initial cohort. Prescriptions and procedures at index, as well as complications up to 12 months postindex, were analyzed. RESULTS Nearly 90% of all patients received a prescription at index. Antibiotics were prescribed for 84.8% patients, followed by antitussives (16.2% for adults, 6.2% for pediatrics), nasal corticosteroids (15.5% adults, 7.5% for pediatrics), and systemic corticosteroids (10.3% for adults, 5.5% for pediatrics), with 49% adults and 29% children receiving >1 medication at first visit. Macrolides were the most frequently prescribed antibiotics (35.6% adults, 28.6% pediatrics), followed by amoxicillin/clavulanate and amoxicillin. Within 12 months of index, 3 patients presented with meningitis and 3 with orbital cellulitis. CONCLUSION Significant variability in ARS treatment was observed, highlighting the need for heightened awareness of existing guidelines.
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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Passali D, Cingi C, Cambi J, Passali F, Muluk NB, Bellussi ML. A survey on chronic rhinosinusitis: opinions from experts of 50 countries. Eur Arch Otorhinolaryngol 2016; 273:2097-109. [PMID: 26742909 DOI: 10.1007/s00405-015-3880-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
Abstract
Chronic rhinosinusitis (CRS) is a very prevalent inflammatory disease. Treatments vary in different countries. In the present study, we explored the approaches of physicians in 50 countries. In this cross-sectional study, a rhinosinusitis survey (RSS) was completed by Honorary and Corresponding Members (otorhinolaryngologists) of the Italian Society of Rhinology. In 79.1 % of the 50 countries, the proportion of patients suffering from CRS was 15 %. Nasal symptoms were more intense in winter (46 % of countries), and spring and autumn (22 %). The most common symptoms were nasal obstruction (86 %), postnasal drip (82 %) and headache (52 %). The most common investigative modalities in the assessment of CRS are paranasal sinus CT, fiberoptic endoscopy, and anterior rhinoscopy. CRS patients were principally treated by otorhinolaryngologists (70 %). Medical treatments included nasal corticosteroids (90 %), nasal washes (68 %), and nasal decongestants (32 %). In 88 % of countries, more than 50 %, or "about 50 %", of all patients reported subjective symptom improvement after treatment. In most of the countries, surgery was required by 20-35 % of all CRS patients. During post-surgery follow-up, nasal washes (90 %), nasal corticosteroids (76 %), and systemic antibiotics (32 %) were prescribed. In 20-40 % of all patients, CRS was associated with nasal polyps. In such patients, the medical treatment options were nasal corticosteroids (90 %), systemic corticosteroids (50 %), nasal washes (46 %), and systemic antibiotics (34 %). Treatment of CRS patients varies in different countries. Paranasal sinus CT is the most common investigative modality in the assessment of CRS, and nasal corticosteroids are the first-line treatment, in the absence or presence of nasal polyps.
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Affiliation(s)
- Desiderio Passali
- Department for ORL Head and Neck Surgery, University of Siena, Siena, Italy
| | - Cemal Cingi
- Department for ORL Head and Neck Surgery, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Jacopo Cambi
- Department for ORL Head and Neck Surgery, University of Siena, Siena, Italy
| | | | - Nuray Bayar Muluk
- Department for ORL Head and Neck Surgery, Faculty of Medicine, Kırıkkale University, Kirikkale, Turkey.
- , Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 Blok, No: 6-3/43, 06610, Çankaya/Ankara, Turkey.
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241
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Shueb SS, Boyer HC, Nixdorf DR. Nonodontogenic "tooth pain" of nose and sinus origin. J Am Dent Assoc 2016; 147:457-9. [PMID: 26762708 DOI: 10.1016/j.adaj.2015.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
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242
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Autio TJ, Koskenkorva T, Närkiö M, Leino TK, Koivunen P, Alho OP. Imaging follow-up study of acute rhinosinusitis. Laryngoscope 2016; 126:1965-70. [DOI: 10.1002/lary.25843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/02/2015] [Accepted: 12/02/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Timo J. Autio
- Department of Otorhinolaryngology and Head and Neck Surgery; Oulu University Hospital; Oulu Finland
- Research Unit of Otorhinolaryngology and Ophthalmology; University of Oulu; Oulu Finland
- Medical Research Center Oulu; Oulu Finland
| | - Timo Koskenkorva
- Department of Otorhinolaryngology and Head and Neck Surgery; Oulu University Hospital; Oulu Finland
- Research Unit of Otorhinolaryngology and Ophthalmology; University of Oulu; Oulu Finland
- Medical Research Center Oulu; Oulu Finland
| | - Mervi Närkiö
- Centre for Military Medicine; Finnish Defence Forces; Riihimäki Finland
| | - Tuomo K. Leino
- Air Force Command Finland; Finnish Defence Forces; Tikkakoski Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology and Head and Neck Surgery; Oulu University Hospital; Oulu Finland
- Research Unit of Otorhinolaryngology and Ophthalmology; University of Oulu; Oulu Finland
- Medical Research Center Oulu; Oulu Finland
| | - Olli-Pekka Alho
- Department of Otorhinolaryngology and Head and Neck Surgery; Oulu University Hospital; Oulu Finland
- Research Unit of Otorhinolaryngology and Ophthalmology; University of Oulu; Oulu Finland
- Medical Research Center Oulu; Oulu Finland
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243
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Kim BN, Kim HB, Oh MD. Antibiotic Control Policies in South Korea, 2000-2013. Infect Chemother 2016; 48:151-159. [PMID: 27704729 PMCID: PMC5047995 DOI: 10.3947/ic.2016.48.3.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Indexed: 01/06/2023] Open
Abstract
Antibiotic stewardship is a key strategy for limiting antibiotic resistance. Over the last decade the South Korean government has implemented a series of healthcare policies directed to this end, consisting of legislative separation of drug prescribing and dispensing, antibiotic utilization reviews, healthcare quality assessment, and public reporting. As a result, the proportion of antibiotic prescriptions for acute upper respiratory tract infections in primary healthcare facilities decreased from 72.9% in 2002 to 42.7% in 2013. However, no significant decrease in antibiotic resistance occurred over the same period in clinically important bacteria such as Streptococcus pneumoniae. These government-driven policies played a pivotal role in improving antibiotic use for outpatients and surgical patients in South Korea. However, to achieve long-lasting successful outcomes, coordinated efforts and communications among the stakeholders, including physicians and medical societies, are needed.
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Affiliation(s)
- Baek Nam Kim
- Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myoung Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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244
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Soudry E, Hwang PH. Acute Frontal Sinusitis. THE FRONTAL SINUS 2016. [PMCID: PMC7178852 DOI: 10.1007/978-3-662-48523-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Uncomplicated acute frontal sinusitis (AFS) is most often associated with an antecedent viral upper respiratory tract infection. Bacterial infection is suspected if symptoms are persistent for at least 10 days.
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245
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Savlevich EL, Kozlov VS, Zharkykh MA. [A study of the efficacy and safety of new cephalosporin in the treatment of acute bacterial rhinosinusitis]. Vestn Otorinolaringol 2016; 81:73-77. [PMID: 28091482 DOI: 10.17116/otorino201681673-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Acute rhinosinusitis is leading in frequency of antibiotic prescribing all over the world. At the same time the problem of antibiotic resistance and safety of antimicrobial drugs becomes more relevant and international. The article describes the basic mechanisms of bacterial resistance and growth of side effects when using macrolides, respiratory fluoroquinilones and β-lactam antibiotics of different types. Formation of IgE-mediated cephalosporin allergy is associated with the side R1 chain. The R1 structure of cephalosporins I and II generations is similar to penicillins, thus creating conditions for cross-allergy progression. R1 of cephalosporins III and IV generations is represented by a qualitatively different chemical compound (aminothiazol-oxime group) that increases the level of tolerance to these antibiotic types. The data of surveillance study are given to evaluate the efficacy and safety of the new drug Spectracef (active substance is cephalosporin of III generation Cefditoren) when treating acute bacterial rhinosinusitis on an outpatient basis.
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Affiliation(s)
- E L Savlevich
- Central State Medical Academy of Department for Presidential Affairs of the Russian Federation, Moscow, Russia, 121359
| | - V S Kozlov
- Central State Medical Academy of Department for Presidential Affairs of the Russian Federation, Moscow, Russia, 121359
| | - M A Zharkykh
- Polyclinic #5 of Department for Presidential Affairs of the Russian Federation, Moscow, Russia, 119121
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246
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Microbial causes of complicated acute bacterial rhinosinusitis and implications for empirical antimicrobial therapy. The Journal of Laryngology & Otology 2015; 130:169-75. [DOI: 10.1017/s0022215115003369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:Very little up-to-date information is available on the microbiology of complicated acute bacterial rhinosinusitis. Reliable microbiology testing is necessary to inform current empirical antimicrobial treatments. This study was conducted in response to recent US guidelines on antimicrobial treatments for acute bacterial rhinosinusitis. It aimed to describe the pathological micro-organisms involved in complicated acute bacterial rhinosinusitis in the UK and their antimicrobial susceptibility.Methods:This study collected retrospective data on cases of complicated acute bacterial rhinosinusitis with sinogenic orbital and/or intracranial infections from 2007 to 2012. Bacteria identified in paranasal sinus pus were compared with those identified in orbital and/or intracranial infections.Results:Streptococcus anginosus group bacteria were isolated from 61.3 per cent of paranasal sinus pus samples, 83.3 per cent of orbital infections and 77.8 per cent of intracranial infections. All S anginosus isolates were sensitive to penicillin; no penicillin-resistant organisms were isolated.Conclusion:S anginosus was the predominant organism isolated from complicated acute bacterial rhinosinusitis samples at our UK centre. S anginosus is sensitive to penicillin, suggesting that penicillin can be used as an appropriate first-line empirical antibiotic for uncomplicated acute bacterial rhinosinusitis.
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247
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Abstract
Acute bacterial sinusitis (ABS) is a common complication of a simple upper respiratory infection. Acute bacterial sinusitis and an upper respiratory infection, however, have different management plans. This article will help clinicians establish when a diagnosis of ABS can be made based on the latest guidelines from the American Academy of Pediatrics. Also covered will be the pathophysiology of ABS, the role of diagnostic imaging, the recognition of complications of ABS, and treatment options.
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248
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Cramer JD, Kern RC, Tan BK, Peters AT, Evans CT, Smith SS. Potential national savings from prescribing guideline-recommended antibiotics for acute rhinosinusitis. Laryngoscope 2015; 126:579-81. [PMID: 26509838 DOI: 10.1002/lary.25719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/25/2015] [Accepted: 09/17/2015] [Indexed: 11/11/2022]
Affiliation(s)
- John D Cramer
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Anju T Peters
- Division of Allergy/Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Charlesnika T Evans
- Department of Preventive Medicine-Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois, U.S.A
| | - Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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249
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Vaz LE, Kleinman KP, Lakoma MD, Dutta-Linn MM, Nahill C, Hellinger J, Finkelstein JA. Prevalence of Parental Misconceptions About Antibiotic Use. Pediatrics 2015; 136:221-31. [PMID: 26195539 PMCID: PMC4516948 DOI: 10.1542/peds.2015-0883] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Differences in antibiotic knowledge and attitudes between parents of Medicaid-insured and commercially insured children have been previously reported. It is unknown whether understanding has improved and whether previously identified differences persist. METHODS A total of 1500 Massachusetts parents with a child <6 years old insured by a Medicaid managed care or commercial health plan were surveyed in spring 2013. We examined antibiotic-related knowledge and attitudes by using χ(2) tests. Multivariable modeling was used to assess current sociodemographic predictors of knowledge and evaluate changes in predictors from a similar survey in 2000. RESULTS Medicaid-insured parents in 2013 (n = 345) were younger, were less likely to be white, and had less education than those commercially insured (n = 353), P < .01. Fewer Medicaid-insured parents answered questions correctly except for one related to bronchitis, for which there was no difference (15% Medicaid vs 16% commercial, P < .66). More parents understood that green nasal discharge did not require antibiotics in 2013 compared with 2000, but this increase was smaller among Medicaid-insured (32% vs 22% P = .02) than commercially insured (49% vs 23%, P < .01) parents. Medicaid-insured parents were more likely to request unnecessary antibiotics in 2013 (P < .01). Multivariable models for predictors of knowledge or attitudes demonstrated complex relationships between insurance status and sociodemographic variables. CONCLUSIONS Misconceptions about antibiotic use persist and continue to be more prevalent among parents of Medicaid-insured children. Improvement in understanding has been more pronounced in more advantaged populations. Tailored efforts for socioeconomically disadvantaged populations remain warranted to decrease parental drivers of unnecessary antibiotic prescribing.
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Affiliation(s)
- Louise Elaine Vaz
- Division of Pediatric Infectious Diseases, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon;
| | - Kenneth P Kleinman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Matthew D Lakoma
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - M Maya Dutta-Linn
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - James Hellinger
- Neighborhood Health Plan, Boston, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts; and
| | - Jonathan A Finkelstein
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): Adult Sinusitis Executive Summary. Otolaryngol Head Neck Surg 2015; 152:598-609. [PMID: 25833927 DOI: 10.1177/0194599815574247] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue featuring the updated "Clinical Practice Guideline: Adult Sinusitis" as a supplement to Otolaryngology-Head and Neck Surgery. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 developed recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. An updated guideline is needed as a result of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, School of Medicine, St Louis, Missouri, USA
| | | | - Itzhak Brook
- Department of Pediatrics, Georgetown University, Washington, DC, USA
| | - Kaparaboyna Ashok Kumar
- Department of Family Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Maggie Kramper
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Richard R Orlandi
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James N Palmer
- Department Otolaryngology, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology Head & Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Anju Peters
- Department of Internal Medicine, Northwestern University Allergy Division, Chicago, Illinois, USA
| | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Davis, California, USA
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