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Lee VME, Low SH, Koh SWC, Szuecs A, Loh VWK, Sundram M, Valderas JM, Hsu LY. Prescribing Antibiotics for Children with Acute Conditions in Public Primary Care Clinics in Singapore: A Retrospective Cohort Database Study. Antibiotics (Basel) 2024; 13:695. [PMID: 39199995 PMCID: PMC11350738 DOI: 10.3390/antibiotics13080695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 09/01/2024] Open
Abstract
Data on primary care antibiotic prescription practices for children in Singapore, which are essential for health care policy, are lacking. We aimed to address this gap and to benchmark prescription practices against international standards. A retrospective cohort database study on antibiotic prescriptions for children (aged < 18 years) who visited six public primary care clinics in Singapore between 2018 and 2021 was conducted. Data were categorised according to the World Health Organization's Access, Watch, Reserve (WHO AWaRe) classification. Quality indicators from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and the National Institute for Health and Care Excellence (NICE) guidelines were used as a measure of appropriateness of antibiotic prescribing at the individual and overall patient level. In 831,669 polyclinic visits by children between 2018 and 2021, there was a significant reduction in mean antibiotics prescribed per month during pandemic years (2020-2021) compared to pre-pandemic (2018-2019) (MD 458.3, 95% CI 365.9-550.7). Most prescriptions (95.8%) for acute conditions fell within the WHO AWaRe "Access" group. Antibiotic prescription significantly exceeded (55.2%) the relevant quality indicator for otitis media (0-20%). The proportion of children receiving appropriate antibiotics for acute respiratory infections (n = 4506, 51.3%) and otitis media (n = 174, 49.4%) was low compared to the quality indicator (80-100%). There is a need to develop local evidence-based primary care antibiotic guidelines, as well as to support the development of stewardship programmes.
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Affiliation(s)
- Vivien Min Er Lee
- Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (S.W.C.K.); (A.S.); (V.W.K.L.); (J.M.V.)
- Department of Family Medicine, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Si Hui Low
- National University Polyclinics, National University Health System, Singapore 609606, Singapore; (S.H.L.); (M.S.)
| | - Sky Wei Chee Koh
- Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (S.W.C.K.); (A.S.); (V.W.K.L.); (J.M.V.)
- Department of Family Medicine, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore
- National University Polyclinics, National University Health System, Singapore 609606, Singapore; (S.H.L.); (M.S.)
| | - Anna Szuecs
- Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (S.W.C.K.); (A.S.); (V.W.K.L.); (J.M.V.)
- Department of Family Medicine, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Victor Weng Keong Loh
- Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (S.W.C.K.); (A.S.); (V.W.K.L.); (J.M.V.)
- Department of Family Medicine, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Meena Sundram
- National University Polyclinics, National University Health System, Singapore 609606, Singapore; (S.H.L.); (M.S.)
| | - José M. Valderas
- Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (S.W.C.K.); (A.S.); (V.W.K.L.); (J.M.V.)
- Department of Family Medicine, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore;
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2
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Baillie VL, Madhi SA, Ahyong V, Olwagen CP. Metagenomic sequencing of post-mortem tissue samples for the identification of pathogens associated with neonatal deaths. Nat Commun 2023; 14:5373. [PMID: 37666833 PMCID: PMC10477270 DOI: 10.1038/s41467-023-40958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
Postmortem minimally invasive tissue sampling together with the detailed review of clinical records has been shown to be highly successful in determining the cause of neonatal deaths. However, conventional tests including traditional culture methods and nucleic acid amplification tests have periodically proven to be insufficient to detect the causative agent in the infectious deaths. In this study, metagenomic next generation sequencing was used to explore for putative pathogens associated with neonatal deaths in post-mortem blood and lung tissue samples, in Soweto, South Africa. Here we show that the metagenomic sequencing results corroborate the findings using conventional methods of culture and nucleic acid amplifications tests on post-mortem samples in detecting the pathogens attributed in the causal pathway of death in 90% (18/20) of the decedents. Furthermore, metagenomic sequencing detected a putative pathogen, including Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, and Serratia marcescens, in a further nine of 11 (81%) cases where no causative pathogen was identified. The antimicrobial susceptibility profile was also determined by the metagenomic sequencing for all pathogens with numerous multi drug resistant organism identified. In conclusion, metagenomic sequencing is able to successfully identify pathogens contributing to infection associated deaths on postmortem blood and tissue samples.
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Affiliation(s)
- Vicky L Baillie
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
- Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
| | - Shabir A Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Vida Ahyong
- Chan Zuckerberg Biohub, 499 Illinois St, San Francisco, CA, 94158, USA
| | - Courtney P Olwagen
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
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Torres-Rojas I, Pérez-Alzate D, Somoza ML, Pfeifer APM, Diaz EH, Jimenez-Rodriguez TW, Sánchez JF, Ruano FJ, Blanca M, Blanca-López N. Clavulanic Acid Is a Leading Culprit Beta-Lactam in Immediate Allergic Reactions to Penicillins. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:201-213. [PMID: 37021506 PMCID: PMC10079519 DOI: 10.4168/aair.2023.15.2.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/20/2022] [Accepted: 09/14/2022] [Indexed: 04/07/2023]
Abstract
PURPOSE Clavulanate, a beta-lactam associated with amoxicillin, is frequently prescribed in patients at all ages. Recent data implicate amoxicillin-clavulanate in up to 80% of beta-lactam allergy cases. We assessed clavulanate's role in inducing allergic reactions to this combination treatment, with a focus on selective immediate reactions. METHODS Adults (≥ 16 years) reporting a history of immediate reactions to amoxicillin-clavulanate were evaluated through a beta-lactam allergological workup, using modified European Academy of Allergy and Clinical Immunology guidelines. Patients first underwent skin testing, and if negative, drug provocation tests. Expected outcomes were: Group A, subjects with immediate reaction to classical penicillin group determinants (penicilloyl polylysine, minor determinants mixture, and/or penicillin G); Group B, subjects with selective immediate reaction to amoxicillin; Group C, subjects with selective immediate reaction to clavulanate and Group D, those immediate reactions with co-sensitization to clavulanate plus penicillin group determinants or amoxicillin. RESULTS Of 1,170 included patients, 104 had immediate reactions: 36.5% to penicillin group determinants (Group A), 26.9% to amoxicillin (Group B), 32.7% to clavulanate (Group C), and 3.8% to clavulanate plus penicillin determinants or amoxicillin (Group D). Diagnosis was made by skin testing in 79%, 75% and 47% of the patients, respectively, in the first 3 groups (P < 0.001). Drug provocation tests were necessary to establish most other diagnoses. Anaphylaxis predominated over urticaria/angioedema in all groups. CONCLUSIONS Selective immediate reactions to clavulanate accounted for over a third of cases with confirmed reactions after amoxicillin-clavulanate intake, with more than half experiencing anaphylaxis. Within this group, skin test sensitivity was below 50%. People taking amoxicillin-clavulanate may also be co-sensitized to both drugs.
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Burvenich R, Dillen H, Trinh NTH, Freer J, Wynants L, Heytens S, De Sutter A, Verbakel JY. Antibiotic use in ambulatory care for acutely ill children in high-income countries: a systematic review and meta-analysis. Arch Dis Child 2022; 107:1088-1094. [PMID: 35948405 PMCID: PMC9685710 DOI: 10.1136/archdischild-2022-324227] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the rate and appropriateness of antibiotic prescribing for acutely ill children in ambulatory care in high-income countries. DESIGN On 10 February 2021, we systematically searched articles published since 2000 in MEDLINE, Embase, CENTRAL, Web Of Science and grey literature databases. We included cross-sectional and longitudinal studies, time-series analyses, randomised controlled trials and non-randomised studies of interventions with acutely ill children up to and including 12 years of age in ambulatory care settings in high-income countries. Pooled antibiotic prescribing and appropriateness rates were calculated using random-effects models. Meta-regression was performed to describe the relationship between the antibiotic prescribing rate and study-level covariates. RESULTS We included 86 studies comprising 11 114 863 children. We found a pooled antibiotic prescribing rate of 45.4% (95% CI 38.2% to 52.8%) for all acutely ill children, and 85.6% (95% CI 73.3% to 92.9%) for acute otitis media, 37.4% (95% CI 30.9% to 44.3%) for respiratory tract infections, and 40.4% (95% CI 29.9% to 51.9%) for other diagnoses. Considerable heterogeneity can only partly be explained by differences in diagnoses. The overall pooled appropriateness rate is 68.5% (95% CI 55.8% to 78.9%, I²=99.8%; 19 studies, 119 995 participants). 38.3% of all prescribed antibiotics were aminopenicillins. CONCLUSIONS Antibiotic prescribing rates for acutely ill children in ambulatory care in high-income countries remain high. Large differences in prescription rates between studies can only partly be explained by differences in diagnoses. Better registration and further research are needed to investigate patient-level data on diagnosis and appropriateness.
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Affiliation(s)
- Ruben Burvenich
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium .,Department of Family Medicine and Primary Healthcare, Ghent University, Ghent, Belgium
| | - Hannelore Dillen
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nhung T H Trinh
- Department of Pharmacy, and PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway
| | - Joseph Freer
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Laure Wynants
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Stefan Heytens
- Department of Family Medicine and Primary Healthcare, Ghent University, Ghent, Belgium
| | - An De Sutter
- Department of Family Medicine and Primary Healthcare, Ghent University, Ghent, Belgium
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Dillen H, Burvenich R, De Burghgraeve T, Verbakel JY. Using Belgian pharmacy dispensing data to assess antibiotic use for children in ambulatory care. BMC Pediatr 2022; 22:12. [PMID: 34980037 PMCID: PMC8720940 DOI: 10.1186/s12887-021-03047-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The desired effect of antibiotics is compromised by the rapid escalation of antimicrobial resistance. Children are particularly at high-risk for unnecessary antibiotic prescribing, which is owing to clinicians' diagnostic uncertainty combined with parents' concerns and expectations. Recent Belgian data on ambulatory antibiotic prescribing practices for children are currently lacking. Therefore, we aim to analyse different aspects of antibiotic prescriptions for children in ambulatory care. METHODS Pharmacy dispensing data on antibiotics for systematic use referring from 2010 to 2019 were retrieved from Farmanet, a database of pharmaceutical dispensations in community pharmacies. Population data were obtained from the Belgian statistical office (Statbel). Descriptive statistics were performed in Microsoft Excel. The Mann-Kendall test for trend analysis and the seasplot function for seasonality testing were conducted in R. RESULTS The past decade, paediatric antibiotic use and expenditures have relatively decreased in Belgian ambulatory care with 35.5% and 44.3%, respectively. The highest volumes of antibiotics for children are prescribed by GPs working in Walloon region and rural areas, to younger children, and during winter. The most prescribed class of antibiotics for children are the penicillins and the biggest relative reduction in number of packages is seen for the sulfonamides and trimethoprim and quinolone antibacterials. CONCLUSIONS Paediatric antibiotic use has decreased in Belgian ambulatory care. Further initiatives are needed to promote prudent antibiotic prescribing in ambulatory care.
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Affiliation(s)
- Hannelore Dillen
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
| | - Ruben Burvenich
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Tine De Burghgraeve
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX26GG, UK
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6
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Antibiotics at birth and later antibiotic courses: effects on gut microbiota. Pediatr Res 2022; 91:154-162. [PMID: 33824448 PMCID: PMC8770115 DOI: 10.1038/s41390-021-01494-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 02/25/2021] [Accepted: 03/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intrapartum antibiotic prophylaxis (IAP) is widely used, but the evidence of the long-term effects on the gut microbiota and subsequent health of children is limited. Here, we compared the impacts of perinatal antibiotic exposure and later courses of antibiotic courses on gut microbiota. METHODS This was a prospective, controlled cohort study among 100 vaginally delivered infants with different perinatal antibiotic exposures: control (27), IAP (27), postnatal antibiotics (24), and IAP and postnatal antibiotics (22). At 1 year of age, we performed next-generation sequencing of the bacterial 16S ribosomal RNA gene of fecal samples. RESULTS Exposure to the perinatal antibiotics had a clear impact on the gut microbiota. The abundance of the Bacteroidetes phylum was significantly higher in the control group, whereas the relative abundance of Escherichia coli was significantly lower in the control group. The impact of the perinatal antibiotics on the gut microbiota composition was greater than exposure to later courses of antibiotics (28% of participants). CONCLUSIONS Perinatal antibiotic exposure had a marked impact on the gut microbiota at the age of 1 year. The timing of the antibiotic exposure appears to be the critical factor for the changes observed in the gut microbiota. IMPACT Infants are commonly exposed to IAP and postnatal antibiotics, and later to courses of antibiotics during the first year of life. Perinatal antibiotics have been associated with an altered gut microbiota during the first months of life, whereas the evidence regarding the long-term impact is more limited. Perinatal antibiotic exposure had a marked impact on the infant's gut microbiota at 1 year of age. Impact of the perinatal antibiotics on the gut microbiota composition was greater than that of the later courses of antibiotics at the age of 1 year.
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7
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Torres-Rojas I, Pérez-Alzate D, Somoza ML, Haroun Diaz E, Ruano Pérez FJ, Prieto-Moreno Pfeifer A, Jimenez-Rodriguez TW, Fernandez Sánchez J, Blanca M, Canto Diez G, Blanca-López N. Patterns of response and drugs involved in hypersensitivity reactions to beta-lactams in children. Pediatr Allergy Immunol 2021; 32:1788-1795. [PMID: 34324747 DOI: 10.1111/pai.13608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Beta-lactams generate different allergenic determinants that induce selective or cross-reactive drug hypersensitivity reactions (DHRs). We aimed to identify the drugs involved, the selectivity of the response, the mechanism, and the value of the different diagnostic tests for establishing a diagnosis in children evaluated for DHRs to beta-lactams. METHODS Prospective study evaluating children aged under 16 years reporting DHRs to beta-lactams. Reactions were classified as immediate and non-immediate reactions. The workup included sIgE, skin testing, and drug provocation tests (DPTs) for immediate reactions and patch testing and DPTs for non-immediate ones. RESULTS Of the 510 children included, 133 were evaluated for immediate reactions and confirmed in 8.3%. Skin test/in vitro IgE contributed to diagnosing half of the cases. Selective reactions occurred with amoxicillin (63%), followed by common penicillin determinants (27%) and cephalosporins (0.9%). Among non-immediate reactions (11.4% of the 377 children evaluated), most required DPTs, 52.7% of which were positive at 6-7 days of drug challenge. Selective reactions were identified with amoxicillin (80%), penicillin G (7.5%), cephalosporins (7.5%), and clavulanic acid (5%). Urticaria and maculopapular exanthema were the most frequent entities. CONCLUSIONS There were few confirmed cases of either type of reaction. Skin testing proved less valuable in non-immediate reactions, over half of which would also have been lost in a short DPT protocol. Selective responders to amoxicillin were more likely to have non-immediate reactions, while clavulanic acid selectivity was exclusive to the non-immediate typology. Over half the cases with DPTs required 6-7 days of treatment for DHR confirmation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Miguel Blanca
- Allergy Unit, Infanta Leonor University Hospital, Madrid, Spain
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8
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Blanca-Lopez N, Atanaskovic-Markovic M, Gomes ER, Kidon M, Kuyucu S, Mori F, Soyer O, Caubet JC. An EAACI Task Force report on allergy to beta-lactams in children: Clinical entities and diagnostic procedures. Pediatr Allergy Immunol 2021; 32:1426-1436. [PMID: 33931922 DOI: 10.1111/pai.13529] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/24/2021] [Indexed: 12/14/2022]
Abstract
Beta-lactam (BL) allergy suspicion is common in children and constitutes a major public health problem, with an impact on patient's health and on medical costs. However, it has been found that most of these reactions are not confirmed by a complete allergic workup. The diagnostic value of the currently available allergy tests has been investigated intensively recently by different groups throughout the world. This has led to major changes in the management of children with a suspected BL allergy. Particularly, it is now well accepted that skin tests can be skipped before the drug provocation test in children with a benign non-immediate reaction to BL. However, there is still a debate on the optimal allergic workup to perform in children with a benign immediate reaction. In addition, management of children with severe cutaneous adverse drug reactions remains difficult. In this review, based on a selection of the most relevant studies found in the literature, we will review and discuss the diagnosis of different forms of BL allergy in children.
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Affiliation(s)
| | | | - Eva R Gomes
- Allergy Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mona Kidon
- Safra Children's Hospital and the Clinical Immunology, Angioedema and Allergy Unit, Chaim Sheba Medical Center, Tel Hashomer, Faculty of Pediatric Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Semanur Kuyucu
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Francesca Mori
- Allergy Unit, Department of Pediatric, Meyer Children's Hospital, Florence, Italy
| | - Ozge Soyer
- Department of Pediatric Allergy, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, Geneva University Hospital, Geneva, Switzerland
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Likopa Z, Kivite-Urtane A, Pavare J. Latvian Primary Care Management of Children with Acute Infections: Antibiotic-Prescribing Habits and Diagnostic Process Prior to Treatment. MEDICINA-LITHUANIA 2021; 57:medicina57080831. [PMID: 34441037 PMCID: PMC8397978 DOI: 10.3390/medicina57080831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to children presenting with infections. Materials and Methods: This cross-sectional study included acutely ill children who consulted eighty family physicians (FP) in Latvia, between November 2019 and May 2020. The data regarding patient demographics, diagnoses treated with antibiotics, the choice of antibiotics and the use of diagnostic tests were collected. Results: The study population comprised 2383 patients aged between one month and 17 years, presenting an acute infection episode, who had a face-to-face consultation with an FP. Overall, 29.2% of these patients received an antibiotic prescription. The diagnoses most often treated with antibiotics were otitis (45.8% of all antibiotic prescriptions), acute bronchitis (25.0%) and the common cold (14.8%). The most commonly prescribed antibiotics were amoxicillin (55.9% of prescriptions), amoxicillin/clavulanate (18.1%) and clarithromycin (11.8%). Diagnostic tests were carried out for 59.6% of children presenting with acute infections and preceded 66.4% of antibiotic prescriptions. Conclusion: Our data revealed that a high level of antibiotic prescribing for self-limiting viral infections in children continues to occur. The underuse of narrow-spectrum antibiotics and suboptimal use of diagnostic tests before treatment decision-making were also identified. To achieve a more rational use of antibiotics in primary care for children with a fever, professionals and parents need to be better educated on this subject, and diagnostic tests should be used more extensively, including the implementation of daily point-of-care testing.
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Affiliation(s)
- Zane Likopa
- Children’s Clinical University Hospital, Vienibas Gatve 45, LV-1004 Riga, Latvia;
- Correspondence:
| | - Anda Kivite-Urtane
- Department of Public Health and Epidemiology, Institute of Public Health, Riga Stradins University, Kronvalda Bulvaris 9, LV-1010 Riga, Latvia;
| | - Jana Pavare
- Children’s Clinical University Hospital, Vienibas Gatve 45, LV-1004 Riga, Latvia;
- Department of Pediatrics, Riga Stradins University, Vienibas Gatve 45, LV-1004 Riga, Latvia
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10
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Farkaš M, Čulina T, Sišul J, Pelčić G, Mavrinac M, Mićović V, Tambić Andrašević A. Impact of antibiotic consumption on the carriage of antibiotic-resistant bacteria by school children. Eur J Public Health 2021; 30:265-269. [PMID: 31373636 DOI: 10.1093/eurpub/ckz137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Antibiotic consumption in the paediatric population is one of the key drivers of the emergence and spread of antimicrobial resistance, which is a serious global threat to public health and clinical medicine. The aims of this study were to investigate systemic antibiotic consumption in school children and to assess the associations among antibiotic consumption, carriage rate and resistance of respiratory pathogens residing in the upper respiratory tract mucosa. METHODS In this prospective study, throat and nasopharyngeal swabs from 450 school children, 6-15 years of age (225 healthy children and 225 patients who were ambulatory treated for upper respiratory tract infection), were processed in 2014 in Rijeka, Croatia, and clinical data were obtained via a questionnaire. RESULTS In total, 17% of the children had consumed an antibiotic in the previous 6 months, including 7% of the healthy children and 27% of the acutely ill patients. The most commonly prescribed antibiotics were amoxicillin (26%), amoxicillin with clavulanic acid (26%) and macrolides (18%). Respiratory pathogens were more frequently isolated from children who had consumed an antibiotic in the previous 6 months [odds ratio (OR) 3.67, P < 0.001]. Antibiotic-resistant bacteria were also more frequent in children who had been exposed to antibiotics (OR 5.44, P < 0.001). CONCLUSIONS Penicillins are the most frequently used antibiotics among school children. The results of this study demonstrate that antibiotic consumption is linked with higher carriage rates and resistance rates of respiratory tract pathogens. Therefore, rational use of antibiotics could prevent the emergence and spread of resistant bacteria.
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Affiliation(s)
- Maja Farkaš
- Department of Microbiology, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia
| | - Tatjana Čulina
- Department of School and University Medicine, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia.,Department of Family Medicine, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | | | - Gordana Pelčić
- Department of Paediatrics, Health Care Centre of Primorsko-Goranska County, Rijeka, Croatia.,Department of Social Sciences and Humanities in Medicine, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | - Martina Mavrinac
- Department of Medical Informatics, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | - Vladimir Mićović
- Department of Environmental Health, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | - Arjana Tambić Andrašević
- Division of Bacteriology and Hospital Infections, Department of Clinical Microbiology, University Hospital for Infectious Diseases 'Dr. Fran Mihaljević', Zagreb, Croatia
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11
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Population Pharmacokinetic Models of Vancomycin in Paediatric Patients: A Systematic Review. Clin Pharmacokinet 2021; 60:985-1001. [PMID: 34002357 DOI: 10.1007/s40262-021-01027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vancomycin is commonly used to treat gram-positive bacterial infections in the paediatric population, but dosing can be challenging. Population pharmacokinetic (popPK) modelling can improve individualization of dosing regimens. The primary objective of this study was to describe popPK models of vancomycin and factors that influence pharmacokinetic (PK) variability in paediatric patients. METHODS Systematic searches were conducted in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, International Pharmaceutical Abstracts and the grey literature without language or publication status restrictions from inception to 17 August 2020. Observational studies that described the development of popPK models of vancomycin in paediatric patients (< 18 years of age) were included. Risk of bias was assessed using the National Heart, Lung and Blood Institute Study Quality Assessment Tool for Case Series Studies. RESULTS Sixty-four observational studies (1 randomized controlled trial, 13 prospective studies and 50 retrospective studies of 9019 patients with at least 25,769 serum vancomycin concentrations) were included. The mean age was 2.5 years (range 1 day-18 years), serum creatinine was 47.1 ± 33.6 µmol/L, and estimated creatinine clearance was 97.4 ± 76 mL/min/1.73m2. Most studies found that vancomycin PK was best described by a one-compartment model (71.9%). There was a wide range of clearance and volume of distribution (Vd) values (range 0.014-0.27 L/kg/h and 0.43-1.46 L/kg, respectively) with interindividual variability as high as 49.7% for clearance and 136% for Vd, proportional residual variability up to 37.5% and additive residual variability up to 17.5 mg/L. The most significant covariates for clearance were weight, age, and serum creatinine or creatinine clearance, and weight for Vd. Variable dosing recommendations were suggested. CONCLUSION Numerous popPK models of vancomycin were derived, however external validation of suggested dosing regimens and analyses in subgroup paediatric populations such as dialysis patients are still needed before a popPK model with best predictive performance can be applied for dosing recommendations. Significant intraindividual and interindividual PK variability was present, which demonstrated the need for ongoing therapeutic drug monitoring and derivation of PK models for vancomycin for certain subgroup populations, such as dialysis patients.
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Galper E, Bdolah‐Abram T, Megged O. Assessment of infections rate due to community-acquired Methicillin-resistant Staphylococcus aureus and evaluation of risk factors in the paediatric population. Acta Paediatr 2021; 110:1579-1584. [PMID: 33249634 DOI: 10.1111/apa.15698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
AIM We aimed at assessing the frequency of Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, identifying its risk factors and evaluating resistance patterns of Staphylococcus aureus to various antibiotics in order to recommend the optimal empirical treatment for suspected Staphylococcus aureus infections. METHODS We reviewed the medical records of children who were treated at Shaare Zedek medical centre, located in Jerusalem, Israel, over the years 2008-2019 and had a positive culture for Staphylococcus aureus. Patients with CA-MRSA infections were compared with Methicillin-susceptible Staphylococcus aureus (CA-MSSA) infections. RESULTS In this study, 620 paediatric patients were included. The number of children in the CA-MRSA study group was 124, while the MSSA control group consisted of 496 children. Risk factors for CA-MRSA infections included young age (1-5 years), female sex, Arab ethnicity and residence in East Jerusalem. The incidence of CA-MRSA increased over the past decade, with an average of 11.2%. An increase in MSSA resistance to clindamycin was noted while Trimethoprim-Sulphamethoxazole resistance remained low. CONCLUSION The incidence of CA-MRSA in Jerusalem was rising, along with changes in resistance patterns of both MSSA and MRSA to various antibiotic agents. In order to optimise empirical treatment for suspected staphylococcal infection, continued monitoring of CA-MRSA prevalence and resistance rates is essential.
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Affiliation(s)
- Ella Galper
- The Hebrew University Hadassah Medical School Jerusalem Israel
| | | | - Orli Megged
- The Hebrew University Hadassah Medical School Jerusalem Israel
- Pediatric department and Pediatric Infectious Diseases Unit Shaare Zedek Medical Center Jerusalem Israel
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13
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Sánchez X, Orrico M, Morillo T, Manzano A, Jimbo R, Armijos L. Reducing unnecessary antibiotic prescription through implementation of a clinical guideline on self-limiting respiratory tract infections. PLoS One 2021; 16:e0249475. [PMID: 33793627 PMCID: PMC8016285 DOI: 10.1371/journal.pone.0249475] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical guidelines (CG) are used to reduce variability in practice when the scientific evidence is sparse or when multiple therapies are available. The development and implementation of evidence-based CG is intended to organize and provide the best available evidence to support clinical decision making in order to improve quality of care. Upper respiratory tract infections (URTI) are the leading cause of misuse of antibiotics and a CG may reduce the unnecessary antibiotic prescription. METHODS The aim of this quasi-experimental, before-after study was to analyze the short- and long-term effects of the implementation of a CG to decrease the rate of antibiotic prescription in URTI cases in the emergency department of a third level private hospital in Quito, Ecuador. The study included 444 patients with a main diagnosis of URTI. They were distributed in three groups: a baseline cohort 2011 (n = 114), a first post-implementation cohort 2011 (n = 114), and a later post-implementation cohort 2018 (n = 216). The implementation strategy consisted of five key steps: acceptance of the need for implementation of the CG, dissemination of the CG, an educational campaign, constant feedback, and sustainability of the strategy through continuous training. RESULTS The results of this study show a 42.90% of antibiotic prescription rate before the CG implementation. After the implementation of the CG, the prescription rate of antibiotics was significantly reduced by 24.5% (42.9% vs 18.4%, p<0.0001) and the appropriate antibiotic prescription rate was significantly increased by 44.2% (22.4% vs 66.6%, p<0.0001) in the first post-implementation cohort 2011. There was not a significant difference in antibiotic prescription rate and appropriate antibiotic prescription rate between two post-implementation cohorts: 18.4% vs 25.9% (p = 0.125) and 66.6% vs 50% (p = 0.191), respectively. CONCLUSIONS The implementation of CGs decreases the rate of antibiotic prescription in URTI cases. The results are remarkable after early implementation, but the effect persists over time. The emphasis must shift from guideline development to strategy implementation.
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Affiliation(s)
- Xavier Sánchez
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Universidad Alcalá de Henares, Madrid, España
| | - María Orrico
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Toa Morillo
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Andrea Manzano
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Ruth Jimbo
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Universidad Alcalá de Henares, Madrid, España
| | - Luciana Armijos
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
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Yu T, Jiang G, Gao R, Chen G, Ren Y, Liu J, van der Mei HC, Busscher HJ. Circumventing antimicrobial-resistance and preventing its development in novel, bacterial infection-control strategies. Expert Opin Drug Deliv 2020; 17:1151-1164. [PMID: 32510243 DOI: 10.1080/17425247.2020.1779697] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Development of new antimicrobials with ever 'better' bacterial killing has long been considered the appropriate response to the growing threat of antimicrobial-resistant infections. However, the time-period between the introduction of a new antibiotic and the appearance of resistance amongst bacterial pathogens is getting shorter and shorter. This suggests that alternative pathways than making ever 'better' antimicrobials should be taken. AREAS COVERED This review aims to answer the questions (1) whether we have means to circumvent existing antibiotic-resistance mechanisms, (2) whether we can revert existing antibiotic-resistance, (3) how we can prevent the development of antimicrobial-resistance against novel infection-control strategies, including nano-antimicrobials. EXPERT OPINION Relying on relieving antibiotic-pressure and natural outcompeting of antimicrobial-resistant bacteria seems an uncertain way out of the antibiotic-crisis facing us. Novel, non-antibiotic, nanotechnology-based infection control-strategies are promising. At the same time, rapid development of new resistance mechanisms once novel strategies is taken into global clinical use, may not be ruled out and must be closely monitored. This suggests focusing research and development on designing suitable combinations of existing antibiotics with new nano-antimicrobials in a way that induction of new antimicrobial-resistance mechanisms is avoided. The latter suggestion, however, requires a change of focus in research and development.
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Affiliation(s)
- Tianrong Yu
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University , Jiangsu, P. R. China.,Department of Biomedical Engineering, University of Groningen and University Medical Center , Groningen, The Netherlands
| | - Guimei Jiang
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University , Jiangsu, P. R. China.,Department of Biomedical Engineering, University of Groningen and University Medical Center , Groningen, The Netherlands
| | - Ruifang Gao
- Department of Biomedical Engineering, University of Groningen and University Medical Center , Groningen, The Netherlands.,College of Chemistry, Chemical Engineering and Materials Science, Soochow University , Suzhou, P.R. China
| | - Gaojian Chen
- College of Chemistry, Chemical Engineering and Materials Science, Soochow University , Suzhou, P.R. China
| | - Yijin Ren
- Department of Orthodontics, University of Groningen and University Medical Center of Groningen , Groningen, The Netherlands
| | - Jian Liu
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University , Jiangsu, P. R. China
| | - Henny C van der Mei
- Department of Biomedical Engineering, University of Groningen and University Medical Center , Groningen, The Netherlands
| | - Henk J Busscher
- Department of Biomedical Engineering, University of Groningen and University Medical Center , Groningen, The Netherlands
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15
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Orlando V, Monetti VM, Moreno Juste A, Russo V, Mucherino S, Trama U, Guida A, Menditto E. Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation. Risk Manag Healthc Policy 2020; 13:63-71. [PMID: 32099490 PMCID: PMC6996207 DOI: 10.2147/rmhp.s223042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/31/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose The purpose was to analyze drug prescription and antibiotic use by age and sex in Italy’s Campania Region, and to estimate the distribution of prescription rates in children (≤14 years old), adults (between 15 and 65 years old), and older adults (≥65 years old) at a municipality level. Methods This was a retrospective analysis of pharmacy records in Campania (Southern Italy), in 2016. Difference in antibiotic prescriptions in different age groups was assessed by prevalence rates. Age-adjusted prevalence rates were categorized into quintiles and mapped by the patient’s municipality of residence. Relationship between prevalence rates for the different age groups was estimated using the non-parametric Spearman rank correlation test. Results There were 2,738,118 were patients with at least one antibiotic prescription. Antibiotics prescription was higher in children aged <5 years and in the older adults aged >70 years. Prevalence rate distribution was different among municipalities in all age groups. A positive correlation between the rank distribution of prevalence rates at municipality level was identified for children and adults (rs=0.56; P<0.01), adults and the older adults (rs=0.79; P<0.01), and children and the older adults (rs=0.46; P<0.01). Among the studied age groups, the most prescribed antibiotic class was penicillin (except the older adults aged ≥85 years) ranging from 45% in children to 27.2% in the older adults. Fluoroquinolones were the least prescribed antibiotic class, ranging from 0.2% in children to 30.2% in the older adults. Conclusion A considerably high use of antibiotic drugs has been detected in Campania Region, with values exceeding the regional and national average. Prescriptions at municipal level differ from one age group to another. Antibiotic use is often unjustified, and to decrease the number of prescriptions and improve their appropriateness, several measures at territorial level are recommended.
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Affiliation(s)
- Valentina Orlando
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | | | - Aida Moreno Juste
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, Spain.,Aragon Health Service (SALUD), Zaragoza, Spain
| | - Veronica Russo
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Sara Mucherino
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Ugo Trama
- Regional Pharmaceutical Unit, Campania Region, Naples, Italy
| | - Antonella Guida
- Directorate-General for Protection of Health, Campania Region, Naples, Italy
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
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16
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Gastine S, Rashed AN, Hsia Y, Jackson C, Barker CIS, Mathur S, Tomlin S, Lutsar I, Bielicki J, Standing JF, Sharland M. GAPPS (Grading and Assessment of Pharmacokinetic-Pharmacodynamic Studies) a critical appraisal system for antimicrobial PKPD studies - development and application in pediatric antibiotic studies. Expert Rev Clin Pharmacol 2019; 12:1091-1098. [PMID: 31747323 DOI: 10.1080/17512433.2019.1695600] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: There are limited data on optimal dosing of antibiotics in different age groups for neonates and children. Clinicians usually consult pediatric formularies or online databases for dose selection, but these have variable recommendations, are usually based on expert opinion and are not graded based on the existing pharmacokinetic-pharmacodynamic (PKPD) studies. We describe here a potential new tool that could be used to grade the strength of evidence emanating from PKPD studies.Areas covered: A scoring system was developed (GAPPS tool) to quantify the strength of each PK assessment and rate the studies quality in already published articles. GAPPS was evaluated by applying it to pediatric PKPD studies of antibiotics from the 2019 Essential Medicines List for children (EMLC), identified through a search of PubMed.Expert opinion: Evidence for most antibiotic dose selection decisions was generally weak, coming from individual PK studies and lacked PKPD modeling and simulations. However, the quality of evidence appears to have improved over the last two decades.Incorporating a formal grading system, such as GAPPS, into formulary development will provide a transparent tool to support decision-making in clinical practice and guideline development, and guide PKPD authors on study designs most likely to influence guidelines.
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Affiliation(s)
- Silke Gastine
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Asia N Rashed
- Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Science, King's College London, London, UK
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.,School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Charlotte Jackson
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Charlotte I S Barker
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Shrey Mathur
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Stephen Tomlin
- Pharmacy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Irja Lutsar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Julia Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.,Paediatric Pharmacology Group, University of Basel Children's Hospital, Basel, Switzerland
| | - Joseph F Standing
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.,Pharmacy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
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Orayj K, Lane E. Patterns and Determinants of Prescribing for Parkinson's Disease: A Systematic Literature Review. PARKINSON'S DISEASE 2019; 2019:9237181. [PMID: 31781365 PMCID: PMC6875178 DOI: 10.1155/2019/9237181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022]
Abstract
Since the discovery of levodopa (L-dopa) in 1967, the range of medications available to treat Parkinson's disease has increased significantly and guidance on the use, efficacy, and safety of these medications has evolved. To assess levels of adherence to national prescribing guidelines and awareness of changes in the efficacy and safety data published in the profiles of medications for the treatment of PD, we have reviewed studies on patterns and determinants of prescribing PD medications conducted in the last 50 years (since the discovery of L-dopa). A systematic literature review was conducted using EMBASE (1967 to March, 2018), Ovid MEDLINE(R) ALL (1967 to March 16, 2018), PsycINFO (1967 to the 2nd week of March, 2018), and PubMed to identify all studies measuring prescribing patterns of PD medication between 1967 and 2017. Study design, source of data, country, year of study, number of patients and/or prescriptions, unit of analysis, prescribing determinants, and percentage utilisation of PD medications were extracted where possible. 44 studies examining prescribing patterns and/or prescribing determinants across 17 countries were identified. Unsurprisingly, L-dopa was the most commonly prescribed medication in all studies, accounting for 46.50% to 100% of all prescriptions for PD. In several studies, the prescribing rate of ergot-derived dopamine agonists (DAs) decreased over time in concordance with guidance. In contrast, the prescribing rates of non-ergot DAs increased over the last ten years in most of the included studies. In examining prescribing factors, two major categories were exemplified, patients' factors and prescribers' factors, with patients' age being the most common factor that affected the prescription in most studies. In conclusion, L-dopa is now the most commonly prescribed medication for cases of PD but there is large variation in the prescribing rates of catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, amantadine, and anticholinergics between countries. New studies examining the effects of recent clinical trials and measuring the prescribing rates of newly approved medications are warranted.
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Affiliation(s)
- Khalid Orayj
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Ave, Cardiff CF10 3NB, UK
- College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Emma Lane
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Ave, Cardiff CF10 3NB, UK
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Barbieri E, Donà D, Cantarutti A, Lundin R, Scamarcia A, Corrao G, Cantarutti L, Giaquinto C. Antibiotic prescriptions in acute otitis media and pharyngitis in Italian pediatric outpatients. Ital J Pediatr 2019; 45:103. [PMID: 31420054 PMCID: PMC6697973 DOI: 10.1186/s13052-019-0696-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Acute otitis media (AOM) and pharyngitis are very common infections in children and adolescents. Italy is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to describe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years, including the prevalence of ‘wait and see’ for AOM, where prescription of antibiotics is delayed 48 h from presentation, and differences in prescribing for pharyngitis when diagnostic tests are used. Methods The study is a secondary data analysis using Pedianet, a database including data at outpatient level from children aged 0–14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described as percentages. “Wait and see” approach rate was described for AOM and pharyngitis prescriptions were further grouped according to the diagnostic test performed and test results. Results We identified 120,338 children followed by 125 family pediatricians between January 2010 and December 2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one AOM diagnosis (n = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis (n = 126,098). 82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate) and the “wait and see” approach was adopted only in 17.5% of cases. The trend over time shows an increase in broad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and among GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed were treated mainly with broad spectrum antibiotics. Conclusions Despite guidance to use the ‘wait and see’ approach in the age group analyzed, this strategy is not often used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription was more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies that diagnostic uncertainty leads to overuse of antibiotics. Electronic supplementary material The online version of this article (10.1186/s13052-019-0696-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Barbieri
- Department for Woman and Child Health, University of Padua, Padua, Italy.
| | - D Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,PENTA Foundation, Padua, Italy
| | - A Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | | | - G Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,PENTA Foundation, Padua, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Pedianet Project, Padua, Italy
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Parviainen S, Saastamoinen L, Lauhio A, Sepponen K. Outpatient antibacterial use and costs in children and adolescents: a nationwide register-based study in Finland, 2008-16. J Antimicrob Chemother 2019; 74:2426-2433. [PMID: 31102531 DOI: 10.1093/jac/dkz208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/08/2019] [Accepted: 04/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe the prevalence of outpatient use and the costs of systemic antibacterials among children and adolescents in Finland during 2008-16 and to examine patterns of use by age and gender. METHODS Data were retrieved from the Finnish statistical database Kelasto, based on the Finnish Prescription Registry. Data included information on dispensed reimbursed prescriptions of antibacterials for systemic use in children aged 0-17 years during 2008-16. The prevalence of antibacterial prescriptions per 1000 children and costs per prescription were calculated. RESULTS The overall prevalence of antibacterial prescriptions decreased in the study period and was highest in 2010 (with 708 prescriptions per 1000 children) and lowest in 2016 (with 374 prescriptions per 1000 children). Children aged 1-2 years had the highest prevalence of antibacterial prescriptions. Furthermore, boys had slightly higher prevalences than girls. The 10 most commonly used antibacterial agents covered ∼97% of all prescriptions and broad-spectrum penicillins were the most commonly used antibacterials. The total costs of antibacterials decreased during the study period, but the costs per prescription increased. CONCLUSIONS This study showed a decreasing trend in the prescribing of antibacterial drugs, regardless of age or gender. Increasing awareness of antimicrobial resistance, reimbursement status changes and pneumococcal and influenza vaccinations are possible reasons for this. Some of the antibacterial oral solutions lost their reimbursement status, but their consumption did not decrease any faster than the consumption of the substances with continuous reimbursability. It is likely that removing the reimbursement status of antibacterials has placed an extra cost burden on families and increased costs per prescription.
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Affiliation(s)
- Sofia Parviainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Leena Saastamoinen
- The Social Insurance Institution of Finland (Kela), Research Unit, Helsinki, Finland
| | - Anneli Lauhio
- The Social Insurance Institution of Finland (Kela), Benefit Services, Helsinki, Finland
| | - Kati Sepponen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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20
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Ciofi degli Atti ML, D’Amore C, Ceradini J, Paolini V, Ciliento G, Chessa G, Raponi M. Prevalence of antibiotic use in a tertiary care hospital in Italy, 2008-2016. Ital J Pediatr 2019; 45:63. [PMID: 31109362 PMCID: PMC6528368 DOI: 10.1186/s13052-019-0645-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/12/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Few data are available about temporal trends of antibiotic use in hospitalized children. The aim of the current study was to investigate the pattern and trends of antibiotic use over the years 2008-2016 in the largest children's hospital in Italy. METHODS Annual point prevalence surveys of antibiotic use were conducted by reviewing medical charts of 0-17 year-old children hospitalized for ≥48 h. Prevalence of antibiotic use was computed by year, type of ward and indication. Trends in prevalence over time were evaluated using the Cochrane-Armitage test. Possibile determinants of antibiotic use were assessed at univariate analysis and through a logistic regression model. RESULTS Out of 3015 children, 1516 (50.3%) received antibiotics, 58.1% of which for medical/surgical prophylaxis. Prevalence of antibiotic use increased from 42.0% in 2008 to 56.2% in 2016 (p = 0.001). The prevalence of patients receiving antibiotics for medical prophylaxis increased from 6.1% in 2008 to 24.2% in 2016 (p < 0.001), whereas the prevalence of patients receiving antibiotics for surgical prophylaxis significantly decreased (from 13.7 to 11.8%; p = 0.04); no significant temporal trends were found in antibiotic use for treating infections. The administration of third-generation cephalosporins for surgical and medical prophylaxis significantly decreased over time, while the proportion of antibiotics prescribed to treat infections after microbiological investigations significantly increased. Year (ORadj: 1.8 in 2016 compared to 2008, p < 0.001), age (ORadj ≥1.5 in children ≥1 year, compared to infants ≤2 months, p < 0.001), length of stay (LOS) (ORadj: 1.4 in case of LOS between 8 and 30 days compared to LOS ≤ 7 days, p < 0.001), and type of ward (ORadj: ≥1.3 in intensive-care, surgical and medical-subspecialty units compared to medical units, p < 0.001) were significantly and independently associated with antibiotic use. CONCLUSIONS Comparing prevalence rates of antibiotic use among hospitals and over time should consider differences in patient characteristics, such as age, ward of hospitalization and length of stay. Over the years, we documented an improvement in the choice of antibiotics prescribed for medical and surgical prophylaxis. However, further efforts are needed to avoid antibiotic misuse for medical prophylaxis, and to reduce the empirical use of broad spectrum antibiotics.
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Affiliation(s)
| | - Carmen D’Amore
- Unit of Clinical Epidemiology, Bambino Gesù Children’s Hospital, Piazza di Sant’Onofrio 4, 00165 Rome, Italy
| | - Jacopo Ceradini
- Medical Direction, Bambino Gesù Children’s Hospital, Piazza di Sant’Onofrio 4, 00165 Rome, Italy
| | - Valerio Paolini
- Medical Direction, Bambino Gesù Children’s Hospital, Piazza di Sant’Onofrio 4, 00165 Rome, Italy
| | - Gaetano Ciliento
- Medical Direction, Bambino Gesù Children’s Hospital, Piazza di Sant’Onofrio 4, 00165 Rome, Italy
| | - Giuseppe Chessa
- Medical Direction, Bambino Gesù Children’s Hospital, Piazza di Sant’Onofrio 4, 00165 Rome, Italy
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, Piazza di Sant’Onofrio 4, 00165 Rome, Italy
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21
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Khanpour Ardestani S, Robinson JL, Dieleman LA, Huynh HQ, Jou H, Vohra S. Surveys of parents and clinicians concerning the minimally important difference of probiotic therapy for prevention of paediatric antibiotic-associated diarrhoea. BMJ Open 2019; 9:e024651. [PMID: 30944130 PMCID: PMC6500342 DOI: 10.1136/bmjopen-2018-024651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To establish the minimally important difference (MID) that would prompt parents and clinicians to use probiotics for prevention of paediatric antibiotic-associated diarrhoea (AAD) and to obtain parent and clinician opinion about the most important outcomes in clinical trials of AAD. METHODS In this survey, parents of children presenting to the emergency department of a Canadian tertiary care children's hospital and paediatricians working in that hospital were approached. A range of potential MIDs were presented and participants selected one that they would require to use probiotics for AAD prevention. In addition, participants were asked to rate a list of outcomes they would consider to be important in clinical trials of AAD. RESULTS In total, 127 parents and 45 paediatricians participated. About 51% (64/125) of parents and 51% (21/41) of clinicians responding to the MID question reported they would use probiotics if it reduced the risk of AAD by 39% (ie, reduce the risk of AAD from 19% to 12%). The most important outcomes to parents, in descending order, were need for hospitalisation, prevention of dehydration, disruption of normal daily activities, diarrhoea duration and physician revisit. Paediatricians considered need for hospitalisation along with physician revisit as the most important outcomes. They rated prevention of dehydration, diarrhoea duration and stool frequency as important outcomes as well. CONCLUSION There is good agreement between parents and clinicians regarding how effective probiotics would need to be in preventing AAD in order to warrant use. This information, along with outcomes perceived to be most important, will help in the design of future clinical trials.
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Affiliation(s)
- Samaneh Khanpour Ardestani
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joan L Robinson
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Levinus A Dieleman
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hien Q Huynh
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hsing Jou
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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22
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Ferrajolo C, Sultana J, Ientile V, Scavone C, Scondotto G, Tari M, Trifirò G, Rossi F, Capuano A. Gender Differences in Outpatient Pediatric Drug Utilization: A Cohort Study From Southern Italy. Front Pharmacol 2019; 10:11. [PMID: 30804779 PMCID: PMC6370720 DOI: 10.3389/fphar.2019.00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/07/2019] [Indexed: 12/27/2022] Open
Abstract
Objective: The aim of this retrospective population-based cohort study is to in-depth investigate gender-specific drug utilization pattern in pediatric outpatient population. Methods: By using a large administrative database of the Local Health Unit of Caserta (Southern Italy), a pediatric cohort from the birth to 18 years was observed over 6 years (from 1st January 2010 to 31st December 2015). Yearly prevalence of drug use per 100 inhabitants as well as the median number of prescriptions was stratifying by gender. Prevalence of acute and recurrent use of the most frequently used active substances was calculated for the year 2015. Results: A decreasing trend in prevalence of drug use (−3.2%, with a reduction of median number of drugs dispensed) was observed in children for both sexes, from 2010 to 2015. In 2015, the drug classes most commonly used among children of any age were modestly but consistently prescribed more to males than to females: systemic anti-infective drugs (M = 43.5%; F = 42.3%), respiratory tract drugs (M = 29.0%; F = 26.1%), and hormones (M = 13.1%; F = 11.3%). Irrespective of gender, beclomethasone was the most utilized active substance in the first 2 years of life, while thereafter amoxicillin/clavulanate in combination. Conclusions: In a large population of pediatric outpatients no major difference was seen between genders, although commonly used drug classes; in particular, antibiotics, respiratory tract drugs and Hormones with corticosteroids for systemic use prescribed modestly but consistently to larger extent in males than females.
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Affiliation(s)
- Carmen Ferrajolo
- Clinical Pharmacology Unit, Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Center of Pharmacovigilance and Pharmacoepidemiology, Campania Region, Naples, Italy
| | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Valentina Ientile
- Clinical Pharmacology Unit, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Messina, Italy
| | - Cristina Scavone
- Clinical Pharmacology Unit, Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Center of Pharmacovigilance and Pharmacoepidemiology, Campania Region, Naples, Italy
| | - Giulia Scondotto
- Clinical Pharmacology Unit, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Messina, Italy
| | | | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Clinical Pharmacology Unit, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Messina, Italy
| | - Francesco Rossi
- Clinical Pharmacology Unit, Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Clinical Pharmacology Unit, Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Center of Pharmacovigilance and Pharmacoepidemiology, Campania Region, Naples, Italy
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Li M, Lu ZK, Amrol DJ, Mann JR, Hardin JW, Yuan J, Cox CL, Love BL. Antibiotic Exposure and the Risk of Food Allergy: Evidence in the US Medicaid Pediatric Population. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:492-499. [PMID: 30468878 DOI: 10.1016/j.jaip.2018.09.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Food allergy is a significant public health concern in the United States, especially in the pediatric population. It places substantial clinical and economic burdens on the health care system. Exposure to antibiotics in early childhood is thought to increase the risk of subsequent food allergy. OBJECTIVE To examine the impact of exposure to antibiotics early in life on time to development of food allergy. METHODS We conducted a population-based matched cohort study using Medicaid data from 28 states. Antibiotic nonusers were matched 1:1 to antibiotic users on date of birth, sex, race, and state. A Cox proportional hazards regression model was used to evaluate the effect of antibiotic exposure on time to development of food allergy. Sensitivity analyses were performed to assess the robustness of study findings. RESULTS We matched 500,647 antibiotic nonusers to 500,647 antibiotic users in the Medicaid pediatric population. In the adjusted Cox proportional hazards regression analysis, antibiotic exposure was significantly associated with faster development of food allergy (hazard ratio, 1.40; 95% CI, 1.34-1.45). The magnitude and significance of the association between antibiotic exposure and food allergy did not change in the sensitivity analyses. A significant association between antibiotic exposure and faster development of food allergy was found in 17 of 28 states. CONCLUSION Compared with antibiotic nonusers, children with antibiotic prescription had an increased risk of food allergy.
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Affiliation(s)
- Minghui Li
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Z Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC
| | - David J Amrol
- Division of Allergy, Asthma and Immunology, Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Joshua R Mann
- Department of Preventive Medicine, School of Medicine and John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Miss
| | - James W Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jing Yuan
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC
| | - Christina L Cox
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC
| | - Bryan L Love
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC.
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24
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de Benedictis FM, Carloni I, Comberiati P, Shields MD, Bush A, Chang AB. Wet Cough and Nasal Symptoms in Children: Can We Do Better? Front Pediatr 2019; 7:459. [PMID: 31956642 PMCID: PMC6949513 DOI: 10.3389/fped.2019.00459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
The causes of chronic cough in children are mainly dependent on the setting and age of the child. Protracted bacterial bronchitis is a frequent cause of morbidity in childhood, and antibiotic treatment is beneficial. Prompt recognition and early treatment is important both to prevent inappropriate use of asthma medications and also progression to bronchiectasis, but the diagnosis should not be made uncritically, because chronic wet cough is not necessarily due to lower airway disease. Upper Airway Cough Syndrome (UACS) is considered by some to cause chronic cough in childhood. Underlying UACS are many common conditions, including allergic rhinitis, adenoiditis and rhinosinusitis. Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific. The role of nasal endoscopy in children with chronic cough and signs suggesting UACS is unclear. Nasal saline solution irrigation is commonly used in UACS, but most studies have methodological biases, and efficacy data are scanty. Randomized controlled trials are urgently required. However, if saline washes, rather than oral antibiotics, can effectively treat some children with wet cough associated with upper airway conditions, antibiotic resistance could potentially be reduced. There is a need to further study wet cough and not to assume it to be equivalent to lower airway infection in all children.
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Affiliation(s)
| | - Ines Carloni
- Department of Child and Mother Health, Salesi Children's Hospital, Ancona, Italy
| | - Pasquale Comberiati
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michael D Shields
- Centre for Experimental Medicine, Royal Belfast Hospital for Sick Children, Queen's University of Belfast, Belfast, United Kingdom
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Imperial School of Medicine, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
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25
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van de Voort EMF, Mintegi S, Gervaix A, Moll HA, Oostenbrink R. Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review. Front Pediatr 2018; 6:260. [PMID: 30349814 PMCID: PMC6186802 DOI: 10.3389/fped.2018.00260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/31/2018] [Indexed: 01/30/2023] Open
Abstract
Introduction: While fever is the main complaint among pediatric emergency services and high antibiotic prescription are observed, only a few studies have been published addressing this subject. Therefore this systematic review aims to summarize antibiotic prescriptions in febrile children at the ED and assess its determinants. Methods: We extracted studies published from 2000 to 2017 on antibiotic use in febrile children at the ED from different databases. Author, year, and country of publishing, study design, inclusion criteria, primary outcome, age, and number of children included in the study was extracted. To compare the risk-of-bias all articles were assessed using the MINORS criteria. For the final quality assessment we additionally used the sample size and the primary outcome. Results: We included 26 studies reporting on antibiotic prescription and 28 intervention studies on the effect on antibiotic prescription. In all 54 studies antibiotic prescriptions in the ED varied from 15 to 90.5%, pending on study populations and diagnosis. Respiratory tract infections were mostly studied. Pediatric emergency physicians prescribed significantly less antibiotics then general emergency physicians. Most frequent reported interventions to reduce antibiotics are delayed antibiotic prescription in acute otitis media, viral testing and guidelines. Conclusion: Evidence on antibiotic prescriptions in children with fever presenting to the ED remains inconclusive. Delayed antibiotic prescription in acute otitis media and guidelines for fever and respiratory infections can effectively reduce antibiotic prescription in the ED. The large heterogeneity of type of studies and included populations limits strict conclusions, such a gap in knowledge on the determining factors that influence antibiotic prescription in febrile children presenting to the ED remains.
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Affiliation(s)
| | - Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Alain Gervaix
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Henriette A. Moll
- Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Rianne Oostenbrink
- Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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26
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Yagupsky P, El Houmami N, Fournier PE. Respiratory carriage of the novel Kingella negevensis species by young children. New Microbes New Infect 2018; 26:59-62. [PMID: 30245832 PMCID: PMC6141676 DOI: 10.1016/j.nmni.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 11/28/2022] Open
Abstract
Kingella negevensis, a novel Kingella species implicated in a pediatric joint infection, has been recently characterized but its epidemiology remains largely unknown. The pharyngeal carriage of K. negevensis was studied by re-examining the results of a previous longitudinal study conducted in a cohort of healthy Israeli children from whom upper respiratory tract specimens were sequentially cultured between the ages of 2 and 36 months. Isolates were identified as K. negevensis by a species-specific nucleic amplification assay and genotyped by pulsed-field gel electrophoresis. β-lactamase production was determined by the nitrocephin test. Kingella negevensis was detected in 26 of 4,472 (0.58%) oropharyngeal cultures obtained from 24 of 716 children (3.35%) and was not isolated from any of 4,472 nasopharyngeal specimens. Following the first 6 months of life during which none of the children was colonized, the prevalence of carriage gradually increased reaching a peak of 1.09% at 24 months of age and decreased thereafter. Kingella negevensis strains showed genomic heterogeneity, and two clones represented 22 of 26 (84.62%) isolates. Twelve of the 26 (46.15%) isolates, belonging to two distinct clones, produced β-lactamase. Kingella negevensis shows remarkable similarities with K. kingae in terms of colonization site, age-related patterns of acquisition and carriage, and clonal distribution of β-lactamase production. Additional research is needed to investigate potential colonization sites of K. negevensis outside the respiratory tract, explore the mechanisms of pharyngeal colonization by the organism, and determine its role as an invasive human pathogen.
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Affiliation(s)
- P Yagupsky
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - N El Houmami
- UMR VITROME, IRD, Aix-Marseille University, Marseille, France
| | - P-E Fournier
- UMR VITROME, IRD, Aix-Marseille University, Marseille, France
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27
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Sumaila AN, Tabong PTN. Rational prescribing of antibiotics in children under 5 years with upper respiratory tract infections in Kintampo Municipal Hospital in Brong Ahafo Region of Ghana. BMC Res Notes 2018; 11:443. [PMID: 29973249 PMCID: PMC6031134 DOI: 10.1186/s13104-018-3542-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the rational use of antibiotics in children with URTIs in the Kintampo Municipal Hospital in Ghana. RESULTS A total of 839 medicines were prescribed, 237 were antibiotics. The mean number of medicines prescribed per patient encounter was 3.1. The percentage of patient encounters with antibiotics was 28.2 and 0.4% for injections. The percentage of medicines prescribed by generic was 93.8% and from the essential medicines list was 94.9%. Ninety-two of patients received amoxicillin. Polypharmacy was common as prescriptions with five to six medicines per patient encounter was found. Some prescribers are not following the WHO/INRUD requirement of prescribing medicines in their generic and from the essential medicine list of the country.
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Affiliation(s)
- Abdul-Nasiru Sumaila
- Pharmacy Department, Jema District Hospital, Ghana Health Services, Accra, Brong Ahafo Region Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Preparing Parents to Make An Informed Choice About Antibiotic Use for Common Acute Respiratory Infections in Children: A Randomised Trial of Brief Decision Aids in a Hypothetical Scenario. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 10:463-474. [PMID: 28258505 DOI: 10.1007/s40271-017-0223-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Childhood acute respiratory infections (ARIs) are one of the most common reasons for primary care consultations and for receiving an antibiotic. Public awareness of antibiotic benefit and harms for these conditions is low. To facilitate informed decision making, ideally in collaboration with their doctor, parents need clear communication about benefits and harms. Decision aids may be able to facilitate this process. OBJECTIVE The aim of this study was to evaluate the effectiveness of three decision aids about antibiotic use for common ARIs in children. METHODS Adult parents of children aged 1-16 years (n = 120) were recruited from community settings and then randomised using a computer-generated randomisation sequence to receive a decision aid (n = 60) or fact sheet (n = 60). Allocation was concealed and used sealed and opaque sequentially numbered envelopes. Participants self-completed questionnaires at baseline and immediately post-intervention. The primary outcome was informed choice (conceptual and numerical knowledge; attitudes towards, and intention to use, antibiotics for a future ARI). Secondary outcomes were decisional conflict, decisional self-efficacy, and material acceptability. RESULTS After reading the information, significantly more intervention group participants made an informed choice [57%] compared with control group participants [29%] [difference 28, 95% confidence interval (CI) 11-45%, p < 0.01], and had higher total knowledge [mean difference (MD) 2.8, 95% CI 2.2-3.5, p < 0.01], conceptual knowledge (MD 0.7, 95% CI 0.4-1.1, p < 0.01) and numerical knowledge (MD 2.1, 95% CI 1.6-2.5, p < 0.01). Between-group differences in attitudes or intention to use antibiotics were not significant. Most intervention group participants found the information understandable and liked the aids' format and features. CONCLUSION The decision aids prepared parents to make an informed choice about antibiotic use more than fact sheets, in a hypothetical situation. Their effect within a consultation needs to be evaluated. Clinical Trials Registration Number: ACTRN12615000843550.
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Russo V, Monetti VM, Guerriero F, Trama U, Guida A, Menditto E, Orlando V. Prevalence of antibiotic prescription in southern Italian outpatients: real-world data analysis of socioeconomic and sociodemographic variables at a municipality level. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:251-258. [PMID: 29765241 PMCID: PMC5939882 DOI: 10.2147/ceor.s161299] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to analyze the geographic variation in systemic antibiotic prescription at a regional level and to explore the influence of socioeconomic and sociodemographic variables. Methods This study was a retrospective analysis of reimbursement pharmacy records in the outpatient settings of Italy’s Campania Region in 2016. Standardized antibiotic prescription rates were calculated at municipality and Local Health Unit (LHU) level. Antibiotic consumption was analyzed as defined daily doses (DDD)/1000 inhabitants per day (DID). Logistic regression was performed to evaluate the association between antibiotic prescription and sociodemographic and socioeconomic determinants at a municipality level. Results The average antibiotic prevalence rate was 46.8%. At LHU level, the age-adjusted prevalence rates ranged from 41.1% in Benevento to 51.0% in Naples2. Significant differences were found among municipalities, from 15.2% in Omignano (Salerno LHU [Sa-LHU]) to 61.9% in Moschiano (Avellino [Av-LHU]). The geographic distribution also showed significant differences in terms of antibiotic consumption, from 6.7 DID in Omignano to 41.6 in San Marcelino (Caserta [Ce-LHU]). Logistic regression showed that both municipality type and average annual income level were the main determinants of antibiotic prescription. Urban municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to rural municipalities (adjusted odds ratio [OR]: 8.62; 95% confidence interval [CI]: 4.06–18.30, P<0.001). Low average annual income level municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to high average annual income level municipalities (adjusted OR: 8.48; 95% CI: 3.45–20.81, P<0.001). Conclusion We provide a snapshot of Campania’s antibiotic consumption, evidencing the impact of both socioeconomic and sociodemographic factors on the prevalence of antibiotic prescription. The observed intraregional variability underlines the lack of shared therapeutic protocols and the need for careful monitoring. Our results can be useful for decision makers to plan educational interventions, thus optimizing health resources and improving rational drug use.
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Affiliation(s)
- Veronica Russo
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II
| | | | | | | | - Antonella Guida
- Directorate-General for Protection of Health, Campania Region, Naples, Italy
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II
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Mihani J, Këlliçi S. Patterns of Antibiotic Prescription in Children: Tirana, Albania Region. Open Access Maced J Med Sci 2018; 6:719-722. [PMID: 29731947 PMCID: PMC5927510 DOI: 10.3889/oamjms.2018.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Antibiotics (abx) constitute the most prescribed therapeutic agent in the world. There is little data regarding antibiotic consumption by young children in Albania. AIM This study aims to evaluate antibiotic prescription in children in quantitative and qualitative terms, and therefore, propose recommendations to improve overall clinical outcomes. METHODS A retrospective, cross-sectional drug utilisation study was conducted based on unreimbursed prescriptions collected in 25 pharmacies, randomly selected within the district of Tirana, during the period beginning December 2015 to January 2016. They contain at least one antibacterial therapeutic agent prescribed for children 0-15 years old, for systemic use. The data were analysed using SPSS 20. RESULTS A group of 904 prescriptions meet inclusion criteria, 54.1% patient were female, and 45.9% were male. The most exposed age group were 2-6 years old. The most common diagnosis was respiratory tract infections: bronchitis (59.2%), tonsillitis (17%) followed by bronchopneumonia (9.6%). The most prescribed antibiotic classes are Penicillins (33%), Cephalosporins (33.2%) and Macrolides (21,5%). Amoxicillin (19.4%), Azithromycin (14.7%), the combination of Amoxicillin and Clavulanic acid (13.5%) and Cefaclor (11.7%) were the most commonly prescribed. We observed short duration therapies, with a mean duration of 5.21 days and in 17.4 % of cases with a duration of ≤ 2 days. CONCLUSIONS We observed a large use of broad-spectrum antibiotics for common respiratory tract infection in children less than 6 years old. We would recommend the creation of an electronic database of patient's record in order to monitor the quality of prescription and education of the healthcare professionals and patient of risks related to antibiotic resistance.
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Affiliation(s)
- Joana Mihani
- Department of Pharmacy in Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Suela Këlliçi
- Department of Pharmacy in Faculty of Medicine, University of Medicine, Tirana, Albania
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Fuchs A, Gotta V, Decker ML, Szinnai G, Baumann P, Bonhoeffer J, Ritz N. Cytokine kinetic profiles in children with acute lower respiratory tract infection: a post hoc descriptive analysis from a randomized control trial. Clin Microbiol Infect 2018; 24:1341.e1-1341.e7. [PMID: 29555393 DOI: 10.1016/j.cmi.2018.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Standard inflammatory markers and chest radiography lack the ability to discriminate bacterial from non-bacterial lower respiratory tract infection (LRTI). Cytokine profiles may serve as biomarkers for LRTI, but their applicability to identify aetiology, severity of disease and need for antibiotic prescription in children remains poorly defined. Objectives were to determine the cytokine kinetic profiles over 5 days in paediatric patients with LRTI, to investigate the relationship between cytokine patterns, and clinical and laboratory variables. METHODS We included patients aged 1 month to 18 years, with febrile LRTI and three consecutive cytokines measurements on days 1, 3 and 5 of a randomized controlled trial (ProPAED study). We evaluated differences in cytokine concentrations between days and associations with clinical and laboratory variables. RESULTS A total of 181 patients (median age 4.1 years) were included; 72/181 (40%) received antibiotics. Serum concentrations of interferon (IFN)-γ, interleukin (IL)-1ra, IL-6, IL-10, IFN-γ-inducible protein (IP)-10 and tumor necrosis factor-α were elevated on day 1 and decreased subsequently, with the greatest decline between day 1 and 3 (by -8 to >-94%). Procalcitonin (PCT) and C-reactive protein (CRP) values showed a protracted decrease with the most prominent reduction in concentrations between days 3 and 5. Significantly elevated IL-6 concentrations were associated with hospital admission, antibiotic treatment, and prolonged antibiotic treatment. Bacteraemic LRTI patients had higher concentrations of IL-1ra (p <0.0055) and IL-6 (p <0.0055) on day 1. CONCLUSIONS We observed an earlier decrease of elevated cytokines compared to PCT or CRP. Both pro- and anti-inflammatory cytokines may serve as markers for severity of LRTI.
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Affiliation(s)
- A Fuchs
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - V Gotta
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - M-L Decker
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - G Szinnai
- Paediatric Endocrinology and Diabetology, University of Basel Children's Hospital, Basel, Switzerland
| | - P Baumann
- Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - J Bonhoeffer
- Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - N Ritz
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland; Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
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Ocan M, Aono M, Bukirwa C, Luyinda E, Ochwo C, Nsambu E, Namugonza S, Makoba J, Kandaruku E, Muyende H, Nakawunde A. Medicine use practices in management of symptoms of acute upper respiratory tract infections in children (≤12 years) in Kampala city, Uganda. BMC Public Health 2017; 17:732. [PMID: 28934933 PMCID: PMC5609015 DOI: 10.1186/s12889-017-4770-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 09/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicines are commonly accessed and used for management of illness in children without a prescription. This potentially increases the risk of unwanted treatment outcomes. We investigated medicine use practices in management of symptoms of acute upper respiratory tract infections among children (≤12 years) in households in Nakawa division, Kampala city. METHODS This was a cross-sectional study conducted among 390 randomly selected children. Data on use of medicines in children (≤12 years) during recent episode of acute upper respiratory tract infection was collected from their care takers using an interviewer administered questionnaire. A recall period of two weeks (14 days) was used in during data collection. RESULTS The prevalence of giving children non-prescription antimicrobial medicines was 44.8% (38.3-52.2). The most common disease symptoms that the children reportedly had included flu, 84.9% (331/390), cough, 83.1% (324/390), and undefined fever, 69.7% (272/390). Medicines commonly given to children included, paracetamol 53.1% (207/390), Coartem 29.7% (116/390), cough linctus 20.8% (81/390), amoxicillin 18.9% (74/390), Co-trimoxazole 18.5% (72/390), and diphenhydramine 15.4% (60/390). The major sources of medicines given to the children was hospital/clinic, 57.26% (223/390). Most of the children, 81% were given more than one medicine at a time. The majority, 62.3% (243/390) of the care takers who gave the children medicine during the recent illness were not aware of any medicine (s) that should not be given to children. The predictors of non-prescription use of antimicrobial medicines in managing symptoms of acute upper respiratory tract infections in children included, medicines obtained from drug shop (PR: 1.45, CI: 1.14-1.85), medicines at home (PR: 1.8, CI: 0.83-1.198) and type of medicine (antimalarial) (PR: 2.8, CI: 1.17-6.68). CONCLUSION Children are commonly given multiple medicines during episodes of acute upper respiratory tract infections with most antimicrobial agents accessed and used without a prescription in Kampala city, Uganda.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Mary Aono
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Clare Bukirwa
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Emmanuel Luyinda
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Cathy Ochwo
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Elastus Nsambu
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Stella Namugonza
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Joseph Makoba
- Department of Pharmacy, College of Health Sciences, Makerere University, P. O. Box, 7072, Kampala, Uganda
| | - Enock Kandaruku
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Hannington Muyende
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Aida Nakawunde
- Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Egunsola O, Choonara I, Sammons HM. Anti-epileptic drug utilisation in paediatrics: a systematic review. BMJ Paediatr Open 2017; 1:e000088. [PMID: 29637124 PMCID: PMC5862211 DOI: 10.1136/bmjpo-2017-000088] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES This study aims to determine global anti-epileptic drug (AED) utilisation prevalence and describe utilisation trends in different countries. METHODS Databases Embase (1980-May 2017), Medline (1946-May 2017) and PubMed were searched for original research on AED utilisation. All paediatric national or regional database studies and surveys were included. RESULTS Twenty-one studies were identified. Five were excluded from the analysis as the data were collected before 2005, leaving 16 studies. Monotherapy regimen varied between 58% and 94% in different countries. In several of the studies, sodium valproate was the most frequently prescribed AED. However, there is a trend towards increasing utilisation of new-generation AEDs, particularly levetiracetam, in some countries. CONCLUSION Monotherapy was used in 58%-94%of patients. There is increasing utilisation of the new-generation AEDs, in particular lamotrigine, levetiracetam and topiramate. Old-generation AEDs are still used in the majority of patients. There is a need for up-to-date studies to determine the prevalence of AEDs in children.
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Affiliation(s)
- Oluwaseun Egunsola
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Imti Choonara
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Helen M Sammons
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
- Department of Paediatrics, North Devon District Hospital, Raleigh Park, Barnstaple, Devon, UK
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Grinlington L, Cranswick N, Gwee A. QUESTION 1: What is the risk of a repeat reaction to amoxicillin or a cephalosporin in children with a history of a non-immediate reaction to amoxicillin? Arch Dis Child 2017; 102:285-288. [PMID: 27998885 DOI: 10.1136/archdischild-2016-312089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/21/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Lisa Grinlington
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| | - Noel Cranswick
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Amanda Gwee
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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Mazińska B, Strużycka I, Hryniewicz W. Surveys of public knowledge and attitudes with regard to antibiotics in Poland: Did the European Antibiotic Awareness Day campaigns change attitudes? PLoS One 2017; 12:e0172146. [PMID: 28212400 PMCID: PMC5315279 DOI: 10.1371/journal.pone.0172146] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/31/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is a global public health problem. Monitoring the level of knowledge regarding antibiotics is a part of the European Union Community strategy against antimicrobial resistance. OBJECTIVE To assess knowledge by the general public in Poland regarding antibiotics, AMR, and the impact of the European Antibiotic Awareness Day campaigns. METHODS The repeated cross-sectional study was developed and carried out among the general public in Poland (in 5 waves between 2009 and 2011, embracing a total of 5004 respondents). The survey was based on a self-designed questionnaire, and carried out by Millward Brown SMG/KRC, using Computer Assisted Telephone Interviews (CATI). RESULTS A high percentage of Polish adults had used antibiotics within the 12 months preceding their participation in the study (38%). Statistically relevant differences were observed regarding the respondents' gender, age, education and employment status. The majority of the antibiotics used were prescribed by physicians (90%). In all five waves, 3% of the respondents purchased an antibiotic without a prescription. Prescriptions were mostly obtained from a general practitioner. The prevailing reasons for taking antibiotics were the common cold, sore throat, cough and flu. Approximately 40% of the respondents expected a prescription for an antibiotic against the flu. The vast majority knew that antibiotics kill bacteria (80%) but at the same time 60% of respondents believed antibiotics kill viruses. Physicians, pharmacists, hospital staff and nurses were mentioned as the most trustworthy sources of information. A third of the respondents declared to have come across information on the prudent use of antibiotics in the preceding 12 months. In the fifth wave, nearly half of the participants (48%), who had come across information about antibiotics in the preceding 12 months declared that the information resulted in a change in their attitude towards antibiotic use. CONCLUSION The survey generated information about the knowledge, attitude, and behavior regarding antibiotics among the general population of Poland. Inappropriate antibiotic use is still highly prevalent in Poland, although a positive trend in behavioral change was observed after the educational campaigns. Additional didactic and systematic education campaigns regarding appropriate antibiotic use are needed and the use of the Internet as an education tool should be enhanced.
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Affiliation(s)
- Beata Mazińska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
- * E-mail:
| | - Izabela Strużycka
- Department of Dental Comprehensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Waleria Hryniewicz
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
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Rosli R, Dali AF, Abd Aziz N, Abdullah AH, Ming LC, Manan MM. Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies. Front Pharmacol 2017; 8:27. [PMID: 28228724 PMCID: PMC5297412 DOI: 10.3389/fphar.2017.00027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/16/2017] [Indexed: 11/13/2022] Open
Abstract
Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized neonates. The present review reveals that neonates are exposed to a high number of drugs and various methods are used to report drug consumption in this age group. The best measure of drug consumption to quantify prevalence of drug use in neonates remains to be identified and additional research in this area is warranted.
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Affiliation(s)
- Rosliana Rosli
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Malaysia
| | - Ahmad Fauzi Dali
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Malaysia
| | - Noorizan Abd Aziz
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Malaysia
| | - Amir Heberd Abdullah
- Department of Environmental Health, Faculty of Health Sciences, Universiti Teknologi MARA Bertam, Malaysia
| | - Long Chiau Ming
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARASelangor, Malaysia; Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, University of TasmaniaHobart, Australia
| | - Mohamed Mansor Manan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARASelangor, Malaysia; School of Pharmacy, KPJ Healthcare University CollegeNilai, Negeri Sembilan, Malaysia
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De Luca M, Donà D, Montagnani C, Lo Vecchio A, Romanengo M, Tagliabue C, Centenari C, D’Argenio P, Lundin R, Giaquinto C, Galli L, Guarino A, Esposito S, Sharland M, Versporten A, Goossens H, Nicolini G. Antibiotic Prescriptions and Prophylaxis in Italian Children. Is It Time to Change? Data from the ARPEC Project. PLoS One 2016; 11:e0154662. [PMID: 27182926 PMCID: PMC4868290 DOI: 10.1371/journal.pone.0154662] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children's hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions. METHODS A 1-day PPS on antibiotic use in hospitalized neonates and children was performed in Italy between October and December 2012 as part of the Antibiotic Resistance and Prescribing in European Children project (ARPEC). Seven institutions in seven Italian cities were involved. The survey included all admitted patients less than 18 years of age present in the ward at 8:00 am on the day of the survey, who had at least one on-going antibiotic prescription. For all patients data about age, weight, underlying disease, antimicrobial agent, dose and indication for treatment were collected. RESULTS The PPS was performed in 61 wards within 7 Italian institutions. A total of 899 patients were eligible and 349 (38.9%) had an on-going prescription for one or more antibiotics, with variable rates among the hospitals (25.7% - 53.8%). We describe antibiotic prescriptions separately in neonates (<30 days old) and children (> = 30 days to <18 years old). In the neonatal cohort, 62.8% received antibiotics for prophylaxis and only 37.2% on those on antibiotics were treated for infection. Penicillins and aminoglycosides were the most prescribed antibiotic classes. In the paediatric cohort, 64.4% of patients were receiving antibiotics for treatment of infections and 35.5% for prophylaxis. Third generation cephalosporins and penicillin plus inhibitors were the top two antibiotic classes. The main reason for prescribing antibiotic therapy in children was lower respiratory tract infections (LRTI), followed by febrile neutropenia/fever in oncologic patients, while, in neonates, sepsis was the most common indication for treatment. Focusing on prescriptions for LRTI, 43.3% of patients were treated with 3rd generation cephalosporins, followed by macrolides (26.9%), quinolones (16.4%) and carbapenems (14.9%) and 50.1% of LRTI cases were receiving more than one antibiotic. For neutropenic fever/fever in oncologic patients, the preferred antibiotics were penicillins with inhibitors (47.8%), followed by carbapenems (34.8%), aminoglycosides (26.1%) and glycopeptides (26.1%). Overall, the 60.9% of patients were treated with a combination therapy. CONCLUSIONS Our study provides insight on the Italian situation in terms of antibiotic prescriptions in hospitalized neonates and children. An over-use of third generation cephalosporins both for prophylaxis and treatment was the most worrisome finding. A misuse and abuse of carbapenems and quinolones was also noted. Antibiotic stewardship programs should immediately identify feasible targets to monitor and modify the prescription patterns in children's hospital, also considering the continuous and alarming emergence of MDR bacteria.
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Affiliation(s)
- Maia De Luca
- Immunology and Infectious Diseases Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Carlotta Montagnani
- Paediatric Infectious Diseases Unit, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences—Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Marta Romanengo
- Acute Care and Emergency Department, G. Gaslini Children's Hospital, Genoa, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Patrizia D’Argenio
- Immunology and Infectious Diseases Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Rebecca Lundin
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Luisa Galli
- Paediatric Infectious Diseases Unit, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences—Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Mike Sharland
- Infection and Immunity, Division of Clinical Sciences, St. Georges University of London, London, United Kingdom
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, Ott H, Atanaskovic-Markovic M, Kidon M, Caubet JC, Terreehorst I. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy 2016; 71:149-61. [PMID: 26416157 DOI: 10.1111/all.12774] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/22/2022]
Abstract
When questioned, about 10% of the parents report suspected hypersensitivity to at least one drug in their children. However, only a few of these reactions can be confirmed as allergic after a diagnostic workup. There is still a lack of knowledge on drug hypersensitivity (DH) epidemiology, clinical spectrum, and appropriate diagnostic methods particularly in children. Meanwhile, the tools used for DH management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of DH and management differ with age. Most reactions in children are still attributed to betalactams. Some manifestations, such as nonsteroidal anti-inflammatory drug-associated angioedema and serum sickness-like reactions, are more frequent among young patients as compared to adults. Risk factors such as viral infections are particularly frequent in children, making the diagnosis challenging. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. This study presents an up-to-date review on epidemiology, clinical spectrum, diagnostic tools, and current management of DH in children. A new general algorithm for the study of these reactions in children is proposed. Data are presented focusing on reported differences between pediatric and adult patients, also identifying unmet needs to be addressed in further research.
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Affiliation(s)
- E. R. Gomes
- Allergology Department; Centro Hospitalar do Porto; Porto Portugal
| | - K. Brockow
- Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Department of Dermatology und AllergologyBiederstein; Technical University Munich; Munich Germany
| | - S. Kuyucu
- Department of Pediatric Allergy and Clinical Immunology; Faculty of Medicine; Mersin University; Mersin Turkey
| | - F. Saretta
- Pediatric Department; Hospital of Palmanova; A.S.S.5 ‘Bassa Friulana’; Palmanova UD Italy
| | - F. Mori
- Allergy Unit; Department of Pediatric; Anna Meyer Children's Hospital; University of Florence; Florence Italy
| | - N. Blanca-Lopez
- Allergy Department; Infanta Leonor University Hospital; Madrid Spain
| | - H. Ott
- Division of Pediatric Dermatology; Children's Hospital Auf der Bult; Hannover Germany
| | - M. Atanaskovic-Markovic
- University Children's Hospital of Belgrade; Medical Faculty University of Belgrade; Belgrade Serbia
| | - M. Kidon
- Allergy and Clinical Immunology Unit and Institute for Pediatric Pulmonology and National CF Center; Safra Children's Hospital; Tel Hashomer Israel
| | - J.-C. Caubet
- Division of Pediatric Allergy; University Hospital of Geneva; Geneva Switzerland
| | - I. Terreehorst
- Department of ENT and Pediatrics; AMC; Amsterdam The Netherlands
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Loureiro RJ, Roque F, Teixeira Rodrigues A, Herdeiro MT, Ramalheira E. O uso de antibióticos e as resistências bacterianas: breves notas sobre a sua evolução. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rpsp.2015.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Anderson de la Llana R, Dubois-Ferriere V, Maggio A, Cherkaoui A, Manzano S, Renzi G, Hibbs J, Schrenzel J, Ceroni D. Oropharyngeal Kingella kingae carriage in children: characteristics and correlation with osteoarticular infections. Pediatr Res 2015; 78:574-9. [PMID: 26186293 DOI: 10.1038/pr.2015.133] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/22/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to investigate changes in oropharyngeal K. kingae carriage during the first 4 y of life, including seasonal variation and comparison of asymptomatic carriage with cases of invasive osteoarticular infections (OAI). METHODS Oropharyngeal bacterial K. kingae carriage was screened in 744 healthy children aged 7-48 mo between January 2009 and December 2012. Oropharyngeal swabs were analyzed by rt-PCR targeting the DNA of K. kingae RTX toxin, epidemiological characteristics of asymptomatic carriers and OAI case patients were recorded. RESULTS The carriage prevalence showed no significant difference between age groups or seasons. Compared with asymptomatic carriers, OAI cases were more likely to be aged from 7 to 12 mo (OR = 2.5; 95% CI (1.2-5.0)) and 13-24 mo (OR = 2.2; 95% CI (1.2-3.9)), and less likely over 36 mo (OR = 0.2; 95% CI (0.1-0.7)). Fewer OAI cases were identified in spring compared to asymptomatic carriers (OR = 0.3; 95% CI (0.1-0.7)), while more were detected in autumn (OR = 2.5; 95% CI (1.4-4.4)). CONCLUSION Although oropharyngeal K. kingae colonization is a prerequisite for further invasive infection, this epidemiological study emphasizes that the carriage rate variations do not correlate with the variations of OAI incidence by gender, season, or age group.
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Affiliation(s)
- Rebecca Anderson de la Llana
- Pediatric Orthopedic Service, University Hospital of Geneva, Geneva, Switzerland.,Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
| | | | - Albane Maggio
- Pediatric Sport Medicine and Obesity Care Program, Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
| | - Abdessalam Cherkaoui
- Clinical Microbiology Laboratory, Service of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Pediatric Emergency Department, Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
| | - Gesuele Renzi
- Clinical Microbiology Laboratory, Service of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
| | - Jonathan Hibbs
- Genomic Research Laboratory, Service of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - Jacques Schrenzel
- Clinical Microbiology Laboratory, Service of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland.,Genomic Research Laboratory, Service of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedic Service, University Hospital of Geneva, Geneva, Switzerland
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Mostafavi N, Rashidian A, Karimi-Shahanjarini A, Khosravi A, Kelishadi R. The rate of antibiotic utilization in Iranian under 5-year-old children with acute respiratory tract illness: A nationwide community-based study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:429-33. [PMID: 26487870 PMCID: PMC4590196 DOI: 10.4103/1735-1995.163952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: To investigate the prevalence of antibiotic usage in children aged <5 years with acute respiratory tract illness (ARTI) in Iran. Materials and Methods: Data were collected from a national health survey conducted in 2010 (Iran's Multiple Indicator Demographic and Health Survey). Participants of this cross-sectional study were selected by multistage stratified cluster-random sampling from 31 provinces of Iran. Parents of children with <5 years of age responded to questions about the occurrence of any cough during the previous 2 weeks, referral to private/governmental/other health care systems, and utilization of any oral/injection form of antibiotics. Data were analyzed using SPSS software18. The chi-square test was used to determine antibiotic consumption in various gender and residency groups and also a place of residence with the referral health care system. Results: Of the 9345 children under 5 years who participated in the study, 1506 cases (16.2%) had ARTI during 2 weeks prior to the interview, in whom 1143 (75.9%) were referred to urban or rural health care centers (43.4 vs. 30.4%; P < 0.001). Antibiotics were utilized by 715 (62.6%) of affected children. Injection formulations were used for 150 (13.1%) patients. The frequency of receiving antibiotics was higher in urban than in rural inhabitants (66.0% vs. 57.7% P < 0.05). Conclusion: The prevalence of total and injection antibiotics usage in children <5 years with ARTI is alarmingly high in Iran. Therefore, interventions to reduce antibiotic use are urgently needed.
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Affiliation(s)
- Nasser Mostafavi
- Department of Pediatric Infectious Diseases, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Karimi-Shahanjarini
- Department of Public Health, School of Public Health, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Ardeshir Khosravi
- Department of Public Health, Technical Group for Health Information System and Secretariat for Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Bozic B, Bajcetic M. Use of antibiotics in paediatric primary care settings in Serbia. Arch Dis Child 2015; 100:966-9. [PMID: 25994002 DOI: 10.1136/archdischild-2015-308274] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/28/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of the study was to compare the quality of antibiotic use among children in primary settings with the internationally developed disease-specific quality indicators and with National Guidelines. DESIGN Prescriptions of systemic antibiotics to the paediatric population (<18 years) at the primary level of healthcare for the period between 2011 and 2013 were analysed by using the National Health Insurance Fund's outpatient reimbursement database. RESULTS The mean annual number of antibiotic prescriptions was 1.887.615, while the mean annual number of children receiving antibiotics was 728.285. The prescription rate slightly decreased by 10% from 1.516 antibiotic prescriptions per 1000 persons per year in 2011 to 1.365 in 2013. The highest percentage of prescribed antibiotics was observed in the group of children aged 2-23 months. The mean annual prevalence of antibiotic prescriptions was 54%. The percentage of patients prescribed an antibiotic for acute upper respiratory tract infections, acute tonsillitis and acute otitis media (AOM) was above the proposed range (≤ 20), 87% -96%. These three diagnoses represent more than 69% of all indications for prescribing antibiotics. The percentage of patients prescribed a recommended antibiotic was below the proposed range (≥ 80%), 1% -17%, while the adherence rate to National Guidelines was low, 19%-28%. The percentage of patients prescribed quinolones was above the proposed range for AOM (≤ 5%), 7%. There were no significant differences in indicators value at the regional level in Serbia. CONCLUSIONS Antibiotic use among children in Serbia is extremely high compared with that in most other European countries. Major problems are frequent use of antibiotics for indications that usually receive no benefit from this treatment and the use of broad-spectrum antibiotics.
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Affiliation(s)
- Bojana Bozic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Bajcetic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia Clinical Pharmacology Unit, University Children's Hospital, Belgrade, Serbia
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Bénard-Laribière A, Jové J, Lassalle R, Robinson P, Droz-Perroteau C, Noize P. Drug use in French children: a population-based study. Arch Dis Child 2015; 100:960-5. [PMID: 25977563 DOI: 10.1136/archdischild-2014-307224] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 04/21/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE To provide an overview of drug use in outpatient children in France, a population-based study using a national reimbursement claims database representative of 90% of the French population was conducted. DESIGN Cross-sectional study performed between January and December 2011 using the EGB database (Echantillon Généraliste de Bénéficiaires), a 1/97th sample of the national healthcare insurance system beneficiaries. Drug use in children <18 years old was estimated through reimbursements for prescribed drugs excluding vaccines. Prevalences of use were calculated for different levels of the Anatomical Therapeutic Chemical classification by considering as users children who had at least one reimbursement during the study period. RESULTS In 2011, 133,800 children were included in the study. The overall prevalence of drug use was 84% and the median number of different drugs per child was 5. Drug use was greatest in children aged <2 years. The most widely used drugs were paracetamol, systemic anti-infectives, nasal corticosteroids and decongestants, and anti-histamines. 21% children <2 years received domperidone. CONCLUSIONS There is widespread use of medicines that are unlikely to be effective and may have significant toxicity in French children. Irrational use of medicines appears to be greatest in children aged 5 years and under.
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Affiliation(s)
| | - Jérémy Jové
- CIC Bordeaux CIC1401, Bordeaux, France ADERA, Pessac, France
| | - Régis Lassalle
- CIC Bordeaux CIC1401, Bordeaux, France ADERA, Pessac, France
| | - Philip Robinson
- CIC Bordeaux CIC1401, Bordeaux, France ADERA, Pessac, France
| | | | - Pernelle Noize
- Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France CIC Bordeaux CIC1401, Bordeaux, France INSERM, U657, Bordeaux, France
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Buccellato E, Melis M, Biagi C, Donati M, Motola D, Vaccheri A. Use of Antibiotics in Pediatrics: 8-Years Survey in Italian Hospitals. PLoS One 2015; 10:e0139097. [PMID: 26405817 PMCID: PMC4584004 DOI: 10.1371/journal.pone.0139097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 09/09/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate antibiotic consumption in the pediatric wards of Emilia-Romagna Region, from 2004 to 2011, with a focus on the antibiotics reserved to the most serious infections, and to analyse the ADRs reported for antibiotics by the pediatric wards of Emilia-Romagna hospitals. Methods Reference population was represented by all the patients (0–14 years old) admitted to the pediatric wards of all the hospitals of Emilia-Romagna Region. Drug consumption was expressed as number of DDDs per 100 Bed-Days (BD) and data were analysed by active substance, by therapeutic subgroups or by ward type. The time trends of antibiotic consumption were statistically analysed by linear regression. All the suspected ADR reports associated with antibiotics, reported between January 2004 and December 2011 were drawn by the Italian Spontaneous Reporting Database. Results Overall antibiotic consumption showed only a slight increase (p = 0.224). Among the pediatric wards, pediatric surgery showed the highest increase from 2004 to 2011 (p = 0.011). Penicillins and β-lactamase inhibitors was the first therapeutic group with a statistically significant increase over years (p = 0.038), whereas penicillins with extended spectrum presented a statistically significant reduction (p = 0.008). Moreover, only 5 drugs out of the 8 antibiotics reserved to the most serious infections were used. Pharmacovigilance data showed 27 spontaneous ADR reports associated to ATC J01 drugs. Amoxicillin/clavulanic acid had the highest number of ADR reports (n = 7). Conclusions The steadily increasing consumption in penicillins and β-lactamase inhibitors, in association with a considerable decrease of plain penicillins, raises a serious concern. Pharmacovigilance reports seem to suggest a safe use of antibiotics in the hospital setting of Emilia-Romagna. Further studies to investigate the reason for prescribing antibiotics in children inpatients are needed.
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Affiliation(s)
- Elena Buccellato
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Mauro Melis
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Chiara Biagi
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Monia Donati
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Domenico Motola
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Alberto Vaccheri
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
- * E-mail:
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Oral penicillin prescribing for children in the UK: a comparison with BNF for Children age-band recommendations. Br J Gen Pract 2015; 64:e217-22. [PMID: 24686886 DOI: 10.3399/bjgp14x677842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The British National Formulary for Children (BNFC) recommends dosing oral penicillins according to age-bands, weight-bands, or weight-based calculations. Because of the rising prevalence of childhood obesity, age-band-based prescribing could lead to subtherapeutic dosing. AIM To investigate actual oral penicillin prescribing by GPs in the UK with reference to the current BNFC age-band recommendations. DESIGN AND SETTING Descriptive analysis of UK prescriptions in the 2010 IMS Disease-Analyzer database (IMS-DA). METHOD A detailed database analysis was undertaken of oral penicillin prescriptions for 0-18 year olds from the 2010 IMS-DA. The prescription analysis included all available data on formulation, strength (mg), prescription quantity unit, package size, prescribed quantity, and volume. RESULTS Considering amoxicillin alone, no infants (aged <1 year) were prescribed the BNFC 2011 edition recommended unit dose (62.5 mg), while the majority received double the dose (125 mg); among children aged 1-5 years, 96% were prescribed the recommended unit dose (125 mg), but 40% of 6-12 year olds and 70% of 12-18 year olds were prescribed unit doses below the BNFC recommendations. For otitis media, only those children aged <1 year received the recommended dose of amoxicillin (40-90 mg/kg/day). Similar variations in dosing across age-bands were observed for phenoxymethylpenicillin and flucloxacillin. CONCLUSION There is wide variation in the dosing of penicillins for children in UK primary care, with very few children being prescribed the current national recommended doses. There is an urgent need to review dosing guidelines, in relation to the weights of children today.
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Matuz M, Benko R, Elseviers M, Hajdu E, Doro P, Viola R, Soos G. Dosage Form Data Used for Estimating Pediatric Antibiotic Use. Sci Pharm 2015; 83:511-8. [PMID: 26839835 PMCID: PMC4727769 DOI: 10.3797/scipharm.1511-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 07/01/2015] [Indexed: 11/22/2022] Open
Abstract
We aimed to report a simple estimation method to enable quantification of pediatric antibiotic exposure in large aggregated datasets. Secondly, we aimed to quantify and benchmark Hungarian pediatric antibiotic use. First we intended to examine whether a correlation existed between dosage form data and the patient's age. Therefore, issued prescriptions were analyzed in pharmacies. As a correlation was found between the share of liquid oral antibacterial products and the rate of pediatric antibiotic prescriptions (R=0.884; p<0.001), we extrapolated this finding to a large aggregated dataset and estimated that 34.6% of prescriptions were issued for pediatric cases (95% confidence interval: 19.7-60.0). Taking into account the demography of the population, children were exposed to antibiotics three times more often than adults with a corresponding annual prescription rate of 2.6. We demonstrated that simple drug-related data can be linked to a patient-related measure as we found strong associations between dosage form data and patients' age. Based on this association, massive pediatric antibiotic exposure was found. Due to the general availability of dosage form data and the ease of the estimation method, the reported concept can be used to quantify pediatric antibiotic use in large aggregated datasets or when age stratification is absent.
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Affiliation(s)
- Maria Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
| | - Ria Benko
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
| | - Monique Elseviers
- Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, CDE R3.29, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Edit Hajdu
- First Internal Medicine, Infectiology Unit, Faculty of Medicine, University of Szeged, Kálvária sgt 57, H-6724 Szeged, Hungary
| | - Peter Doro
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
| | - Reka Viola
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
| | - Gyongyver Soos
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8., H-6725 Szeged, Hungary
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Alanazi MQ, Al-Jeraisy MI, Salam M. Prevalence and predictors of antibiotic prescription errors in an emergency department, Central Saudi Arabia. Drug Healthc Patient Saf 2015; 7:103-11. [PMID: 26082662 PMCID: PMC4461133 DOI: 10.2147/dhps.s83770] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Inappropriate antibiotic (ATB) prescriptions are a threat to patients, leading to adverse drug reactions, bacterial resistance, and subsequently, elevated hospital costs. Our aim was to evaluate ATB prescriptions in an emergency department of a tertiary care facility. METHODS A cross-sectional study was conducted by reviewing charts of patients complaining of infections. Patient characteristics (age, sex, weight, allergy, infection type) and prescription characteristics (class, dose, frequency, duration) were evaluated for appropriateness based on the AHFS Drug Information and the Drug Information Handbook. Descriptive and analytic statistics were applied. RESULTS Sample with equal sex distribution constituted of 5,752 cases: adults (≥15 years) =61% and pediatrics (<15 years) =39%. Around 55% complained of respiratory tract infections, 25% urinary tract infections (UTIs), and 20% others. Broad-spectrum coverage ATBs were prescribed for 76% of the cases. Before the prescription, 82% of pediatrics had their weight taken, while 18% had their weight estimated. Allergy checking was done in 8% only. Prevalence of inappropriate ATB prescriptions with at least one type of error was 46.2% (pediatrics =58% and adults =39%). Errors were in ATB selection (2%), dosage (22%), frequency (4%), and duration (29%). Dosage and duration errors were significantly predominant among pediatrics (P<0.001 and P<0.0001, respectively). Selection error was higher among adults (P=0.001). Age stratification and binary logistic regression were applied. Significant predictors of inappropriate prescriptions were associated with: 1) cephalosporin prescriptions (adults: P<0.001, adjusted odds ratio [adj OR] =3.31) (pediatrics: P<0.001, adj OR =4.12) compared to penicillin; 2) UTIs (adults: P<0.001, adj OR =2.78) (pediatrics: P=0.039, adj OR =0.73) compared to respiratory tract infections; 3) obtaining weight for pediatrics before the prescription of ATB (P<0.001, adj OR =1.83) compared to those whose weight was estimated; and 4) broad-spectrum ATBs in adults (P=0.002, adj OR =0.67). CONCLUSION Prevalence of ATB prescription errors in this emergency department was generally high and was particularly common with cephalosporin, narrow-spectrum ATBs, and UTI infections.
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Affiliation(s)
| | - Majed I Al-Jeraisy
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Mahmoud Salam
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
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Kourlaba G, Kourkouni E, Spyridis N, Gerber JS, Kopsidas J, Mougkou K, Lourida A, Zaoutis TE. Antibiotic prescribing and expenditures in outpatient paediatrics in Greece, 2010-13. J Antimicrob Chemother 2015; 70:2405-8. [PMID: 25881618 DOI: 10.1093/jac/dkv091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/18/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objectives of this study were to provide a nationally representative analysis of antibiotic prescribing in outpatient paediatrics and to assess overall and class-specific antibiotic costs in Greece. METHODS Data on antibiotic prescriptions for patients aged ≤19 years old between July 2010 and June 2013 in Greece were extracted from the IMS Health Xponent database. Antibiotics were grouped into narrow- and broad-spectrum agents. The number of prescribed antibiotics and census denominators were used to calculate prescribing rates. The total costs associated with prescribed antibiotics were calculated. RESULTS More than 7 million antibiotics were prescribed during the study period, with an annual rate of 1100 antibiotics/1000 persons. Prescribing rates were higher among children aged <10 years old. Acute respiratory tract infections (ARTIs) accounted for 80% of prescribed antibiotics, with acute otitis media (22.3%), acute tonsillitis (19.5%) and acute bronchitis/bronchiolitis (13.9%) being the most common clinical diagnoses. Cephalosporins (32.9%), penicillins (32.3%) and macrolides (32.1%) were the most commonly prescribed antibiotic classes. The majority (90.4%) of antibiotics were broad spectrum. Antibiotic expenditures totalled ∼€50 million. CONCLUSIONS Broad-spectrum antibiotic prescribing is common in outpatient paediatric patients. These data provide important targets to inform the development of an outpatient antimicrobial stewardship programme targeting specific practices, providers and conditions.
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Affiliation(s)
- Georgia Kourlaba
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Eleni Kourkouni
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Nikos Spyridis
- Aglaia Kyriakou Children's Hospital, Second Department of Pediatrics, University of Athens School of Medicine, Athens, Greece
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, UPENN School of Medicine, Philadelphia, PA, USA
| | - John Kopsidas
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Katerina Mougkou
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Athanasia Lourida
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Theoklis E Zaoutis
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece Division of Infectious Diseases, Children's Hospital of Philadelphia, UPENN School of Medicine, Philadelphia, PA, USA
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Augustin J, Mangiapane S, Kern WV. A regional analysis of outpatient antibiotic prescribing in Germany in 2010. Eur J Public Health 2015; 25:397-9. [PMID: 25788474 DOI: 10.1093/eurpub/ckv050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to investigate whether the previously reported regional variation in outpatient antimicrobial use density in Germany has persisted or changed over time and has been similar for both children and adults. Antibiotic [at least 1 Anatomical Therapeutic Chemical (ATC) Code 'J01' drug] prescription prevalence data for the year 2010 were analysed for 17 regions. The overall age-standardized antibiotic prescription prevalence ranged between 25.0 and 36.6% in the different regions. Regional prescription patterns for children differed from those seen in adults. Age-specific differences in antibiotic prescription prevalence need to be considered when comparing antibiotic consumption between regions.
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Affiliation(s)
- Jobst Augustin
- 1 Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Mangiapane
- 2 National Association of Statutory Health Insurance Physicians, Staff Unit for Strategic Analyses and IT-Consulting, Berlin, Germany
| | - Winfried V Kern
- 3 Center for Infectious Diseases and Travel Medicine, University of Freiburg-Medical Center, Freiburg, Germany
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Abstract
Kingella kingae is a common etiology of pediatric bacteremia and the leading agent of osteomyelitis and septic arthritis in children aged 6 to 36 months. This Gram-negative bacterium is carried asymptomatically in the oropharynx and disseminates by close interpersonal contact. The colonized epithelium is the source of bloodstream invasion and dissemination to distant sites, and certain clones show significant association with bacteremia, osteoarthritis, or endocarditis. Kingella kingae produces an RTX (repeat-in-toxin) toxin with broad-spectrum cytotoxicity that probably facilitates mucosal colonization and persistence of the organism in the bloodstream and deep body tissues. With the exception of patients with endocardial involvement, children with K. kingae diseases often show only mild symptoms and signs, necessitating clinical acumen. The isolation of K. kingae on routine solid media is suboptimal, and detection of the bacterium is significantly improved by inoculating exudates into blood culture bottles and the use of PCR-based assays. The organism is generally susceptible to antibiotics that are administered to young patients with joint and bone infections. β-Lactamase production is clonal, and the local prevalence of β-lactamase-producing strains is variable. If adequately and promptly treated, invasive K. kingae infections with no endocardial involvement usually run a benign clinical course.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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