Beta-lactamase production in Branhamella catarrhalis isolated from lower respiratory tract secretions in Danish children: an increasing problem

A population-based study of antibiotic prescriptions for Danish children

BACKGROUND

The aim of the study was to examine the use of systemic and topical antibiotics in relation to age and sex in Danish children.

METHODS

We used the Pharmacoepidemiological Prescription Database to identify the individual prescriptions of antibiotics provided for all 0-to 15-year-old children in North Jutland County, Denmark, during 1997. The population was approximately 95000 children.

RESULTS

We identified 44640 prescriptions for systemic antibiotics. The annual prescription rate was highest in the 1- to 2-year-olds, with 945 prescriptions/1000 children/year. One-half of these children received at least 1 prescription, and 12% received 3 or more prescriptions. Among the 11- to 15-year-old children 17% received one or more prescriptions. Overall 88% of the prescriptions were penicillins and 10% were macrolides. In children younger than 3 years 57% of prescriptions were for broad spectrum penicillins, but in children older than 6 years penicillin V was the most frequently used antibiotic. We identified 12 661 prescriptions for topical antibiotics used in eye infections. The prescription rate peaked in the 1- to 2-year-old children, one-third of whom received at least 1 prescription.

CONCLUSIONS

Almost two-thirds of the 0- to 2-year-old children in the population were treated with either systemic or topical antibiotics during 1 year. Physicians prescribe mostly penicillins, but the proportion of broad spectrum penicillins for young children was so high, however, that enforcement of national guidelines should be reconsidered.

Branhamella catarrhalis in children and adults. A study of prevalence, time of colonisation, and association with upper and lower respiratory tract infections

The colonisation rate of Branhamella catarrhalis in patients from 0 to 45 years of age was examined. Of 561 women admitted to hospital in labour, 6 (1%) carried B. catarrhalis in their throats but none carried the organism in their vaginas. None of 534 newborn babies became colonised at birth or during their 5 days' stay in hospital. Neither were 102 neonates < 1 month of age in hospital colonised. The maximum colonisation rate during childhood was observed in children 1-48 months of age with 143 of 266 (54%) children colonised. Among children 4-15 years of age, four of 57 (7%) children with healthy respiratory tracts were colonised. Significantly more children with upper or lower respiratory tract infections (RTI) were colonised (68%) than were children without such infections (36%), (P < 0.001). After recovery from RTI, the isolation rate in the RTI group fell to that of the non-RTI group. A seasonal variation in prevalence was not observed. Of all the strains of B. catarrhalis isolated, 84% produced beta-lactamase.

Moraxella catarrhalis in upper respiratory tract of healthy Yemeni children/adults and paediatric patients: detection and significance

A highly variable carriage rate of Moraxella catarrhalis has been reported in the literature. In order to assess the reasons for this variability, detection rates of this organism from various sites of the upper respiratory tract of children and adults were studied. Throat swabs, oral swabs and nasal swabs from 131 children, 96 adults and 64 paediatric patients with upper respiratory tract infections were cultured on a selective medium. Detection rates of 31.4% in children less than three years of age, 38.5% in children between 4 and 12 years, 11.7% in adults and 21.9% in patients were found, respectively. The reasons for high variability in the carriage rates were many including the number and site of specimen collection, media used for isolation and identification criteria. All isolates were sensitive to amoxycillin-clavulanic acid and co-trimoxazole. A significantly higher share of M. catarrhalis isolates from patients were beta-lactamase producers (12/14, 85.7%) as compared to normal healthy subjects (41.9%), suggesting a cautious approach in the use of beta-lactam antibiotic in respiratory tract infections.

Parenteral-oral switch in the management of paediatric pneumonia

In phase I of a 2-phase study, 56 evaluable children (0.8 to 5 years) with lobar or segmental pneumonia received intravenous or intramuscular ceftriaxone 50 mg/kg/day for 2 days followed by oral cefetamet pivoxil 20 mg/kg/day in 2 divided doses to complete 7 days of treatment. All patients achieved a clinical cure. In phase II, a randomised open multicentre study, 62 children with pneumonia received an identical regimen to phase I (arm A), and 59 children received ceftriaxone 50 mg/kg/day for 1 day followed by 6 days' treatment with cefetamet pivoxil 20 mg/kg/day (arm B). Patients from phase I and arm A were combined giving a total of 118 evaluable patients in arm A. At the end of treatment, 100% of patients in arm A and 96% in arm B achieved a clinical cure; cure was maintained in 99 and 98% of patients, respectively. Two (4%) patients in arm B failed therapy; in both cases, factors other than treatment failure may have accounted for the poor response. 11 and 12% of patients in treatment arms A and B, respectively, experienced adverse events; gastrointestinal events (nausea and/or vomiting) were reported in 9 and 8% of patients, respectively. In conclusion, 1 or 2 days' treatment with parenteral ceftriaxone before switching to oral cefetamet pivoxil was safe and effective in the treatment of childhood pneumonia. Therefore, parenteral-oral switch is a feasible treatment option in the treatment of serious paediatric community-acquired pneumonia.