Management of community-acquired pneumonia in infants and children: Clinical practice guidelines endorsed by the Saudi Pediatric Infectious Diseases Society

Systematic review of clinical practice guidelines on the management of community acquired pneumonia in children

Childhood community acquired pneumonia (CAP) is the leading cause of mortality in children under 5 years worldwide. Clinical practice guidelines (CPGs) may be limited by method of development, scope of recommendations and the quality of supporting evidence. This study systematically identified, appraised and compared the recommendations of CPGs for the management of paediatric CAP using the AGREE II tool. The systematic review yielded 1409 non-duplicate results, of which 14 CPGs were appraised. Four of the fourteen CPGs were deemed high quality. Most CPGs were considered low-medium quality with 'rigour of development' and 'applicability' the weakest domains. These areas should be considered in deriving CPGs in the future. Recommendations were generally similar across all guidelines; however, there was notable heterogeneity in three areas. This suggests the need for further evidence to guide management decisions on oxygen saturation thresholds for admission, the utility of investigations such as acute phase reactants, and the duration of antibiotic therapy.

The therapeutic effects of naringenin on bronchial pneumonia in children

Bronchial pneumonia in children is a common infectious disease in toddlers and infants, which may cause hyperpyrexia, pulmonary moist rales, and even respiratory failure. Traditional drugs for bronchial pneumonia in children often lead to drug resistance and side effects. Recently, naringenin has been reported to be a potential treatment for several airway inflammatory diseases due to its anti-inflammatory and anti-microbial activities. The current clinical study aimed to evaluate the safety and therapeutic effect of naringenin in treating bronchial pneumonia in children. A total of 180 eligible patients were randomly assigned into naringenin (NAR) group and azithromycin (AZI) group. All participants were required to follow a 5-day oral administration, and their serum cytokine levels were measured during the clinical intervention. After the treatment, the disappearance time of clinical symptoms, and the incidences of complications and adverse reactions were compared between the two groups. Naringenin was able to inhibit inflammation, shorten the disappearance time of clinical symptoms, reduce the incidences of bronchial pneumonia complications and related adverse reactions, and improve the health conditions of the patients. Our results suggested that naringenin was safe and beneficial to children with bronchial pneumonia, providing new insights into the clinical application of naringenin.

Antibiotic Prescribing Patterns for Hospitalized children with Community-Acquired Pneumonia in a Secondary Care Center

BACKGROUND

Narrow-spectrum antibiotics are recommended as the first-line therapy for management of children hospitalized with community-acquired pneumonia (CAP). There are limited data evaluating the antibiotic prescription patterns for CAP in Saudi Arabia. The goal of this study to report on the antibiotic patterns in children hospitalized with CAP.

METHODS

A prospective cross-sectional study was conducted in children aged 1 month to 13 years who were hospitalized with a diagnosis of CAP at King Khalid Hospital in Majmaah, Saudi Arabia, between January 2019 and January 2020.

RESULTS

Data from 233 patients were collected. The majority of patients received amoxicillin clavulanate (57.9%), followed by ceftriaxone (30%), azithromycin (20.6%), cefuroxime (6%), ampicillin (2.1%), and piperacillin-tazobactam (2.1%). None of our patients were started on narrow-spectrum therapy. The younger age group (1-3 months) and patients with severe pneumonia were more likely to receive broad-spectrum cephalosporin and have a longer hospital stay (P = .000 and P = .002, respectively). However, the 4 months to 5 years age group was more likely to receive amoxicillin clavulanate (P = .001). Male gender was a significate risk factor for patients with severe pneumonia (P=.013) CONCLUSIONS: We demonstrated the inappropriate use of broad-spectrum therapy in children hospitalized with CAP. Further large multicenter studies are necessary to evaluate the patterns of antibiotic use and implement antimicrobial stewardship programs or quality-improvement projects to improve adherence to guidelines.

Efficacy of Zinc as Adjuvant Therapy in the Treatment of Severe Pneumonia in Hospitalized Children: A Randomized Clinical Trial

Background: Pneumonia remains one of the leading causes of childhood mortality and morbidity in developing countries. Studies showed that zinc supplementation can prevent pneumonia, but its therapeutic effectiveness has not been determined definitively. Objectives: This study evaluated the effect of zinc supplementation as adjuvant treatment on children with severe pneumonia admitted to 17th Shahrivar Training Hospital in Rasht, Iran. Methods: In this double-blind placebo-controlled clinical trial, 120 children aged two to 60 months hospitalized for pneumonia were randomly divided into 2 groups of size 60 each. The first group received zinc sulfate (20 mg daily for children twelve months of age or older and 10 mg daily for children younger than 12 months), and the second group received a placebo for seven days. All patients received standard antibiotic treatment for pneumonia. The children were daily evaluated, and recovery time for fever and tachypnea (as primary outcomes) and duration of hospitalization and mortality rate (as secondary outcomes) were compared between the two groups. Results: The mean age of patients was 14.1 months ± 13.9. The youngest and oldest patients were aged 2 and 60 months, respectively. No significant difference in age and sex distribution was found between the two groups. The zinc receiving group experienced a considerably shorter time of fever (2.1 days vs. 2.84 days, P < 0.05) and tachypnea (1.75 days versus 2.1 days, P = 0.011). There was no significant difference in the duration of admission between the two groups (P = 0.728), and no cases of death occurred in either group. Conclusions: This study showed that adjuvant treatment with zinc in children aged 2 to 60 months with severe pneumonia accelerates recovery from pneumonia. Further studies are needed to investigate the effects of administering zinc as adjunctive therapy for pneumonia in other age groups.

Trends in antimicrobial susceptibility patterns in King Fahad Medical City, Riyadh, Saudi Arabia

Objectives:

To describe and interpret local antibiograms from a single tertiary care center to monitor the trends of antimicrobial resistance (AMR) patterns and establish baseline data for further surveillance.

Methods:

We performed a retrospective descriptive review of antibiograms data between January 2010 and December 2015 from King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.

Results:

A total of 51,491 isolates were identified, and most were gram-negative (76.2%). Escherichia coli was the most frequently isolated organism (36.8%), followed by Coagulase-negative Staphylococcus (28.4%) and Staphylococcus aureus (27.5%). The detection of antibiotic-resistant organisms, especially extended-spectrum beta-lactamase-producing Escherichia coli (31%-41%), increased over time. The sensitivity of Streptococcus pneumoniae to penicillin improved from 66% to 100% (p<0.001). Gram-negative isolates had excellent overall susceptibility to amikacin, variable susceptibility to piperacillin-tazobactam and carbapenems, and declining susceptibility to ceftazidime, ciprofloxacin, and cefepime.

Conclusion:

Streptococcus pneumoniae susceptibility to penicillin significantly improved over time, which might be because of the introduction of the pneumococcal vaccine. Conversely, the upward trend in resistant gram-negative organisms is worrisome and warrants the implementation of antimicrobial stewardship programs.