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Zhou P, Wang X, Zhang X, Xu B, Tong X, Zhou W, Shen K, Zhai S. Recommendations on off-label use of intravenous azithromycin in children. Int J Clin Pract 2021; 75:e14010. [PMID: 33421260 DOI: 10.1111/ijcp.14010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/17/2020] [Accepted: 12/08/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Intravenous azithromycin (AZM) has been widely used in children worldwide, but there still remains much concern regarding its off-label use, which urgently needs to be regulated. Therefore, we developed a rapid advice guideline in China to give recommendations of rational use of intravenous AZM in children. METHODS This guideline focuses on antimicrobial therapy with intravenous AZM in children. The Delphi research method was used to select questions. A systematic literature review was also conducted. Data were pooled and ranked according to the GRADE system. Recommendations were developed based on expert clinical experience, patients' values and preferences, and evidence availability. After an external review, the recommendations were revised and approved. RESULTS This guideline included eighteen recommendations that covered four domains: (a) Indications: the treatment of pneumonia caused by atypical but common pathogens, such as Mycoplasma pneumoniae, Chlamydia trachomatis or Chlamydophila pneumoniae and Legionella pneumophila, more typical bacteria as well as the treatment of bronchitis of presumed bacterial aetiologies; (b) Usage and dosage: administration route, infusion concentrations, treatment duration, course of sequential treatment, and dosage stratified by age; (c) Adverse reactions and treatment: the management of gastrointestinal reactions, arrhythmias, pain or phlebitis at the infusion site, and anaphylaxis; and (d) Special population: children with renal or liver dysfunction, congenital heart disease, and obesity. This guideline will hopefully help promote a rational use of intravenous AZM in children worldwide. CONCLUSION This guideline has summarised the evidence and has developed recommendations on the use of intravenous AZM in children worldwide. Further attention and well-designed researches should be conducted on the off-label use of intravenous AZM in children.
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Affiliation(s)
- Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Xiaoling Wang
- National Center for Children's Health, Beijing, China
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xianglin Zhang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Baoping Xu
- National Center for Children's Health, Beijing, China
- Department of Respiration, Beijing Children's Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Respiratory Disease, Beijing, China
- Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association, Beijing, China
| | - Xiaomei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Wei Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Kunling Shen
- National Center for Children's Health, Beijing, China
- Department of Respiration, Beijing Children's Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Respiratory Disease, Beijing, China
- Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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Ahmed S, Applegate JA, Mitra DK, Callaghan-Koru JA, Mousumi M, Khan AM, Joarder T, Harrison M, Ahmed S, Begum N, Quaiyum A, George J, Baqui AH. Implementation research to support Bangladesh Ministry of Health and Family Welfare to implement its national guidelines for management of infections in young infants in two rural districts. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:41. [PMID: 31810496 PMCID: PMC6898944 DOI: 10.1186/s41043-019-0200-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND World Health Organization revised the global guidelines for management of possible serious bacterial infection (PSBI) in young infants to recommend the use of simplified antibiotic therapy in settings where access to hospital care is not possible. The Bangladesh Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GOB) adopted these guidelines, allowing treatment at first-level facilities. During the first year of implementation, the Projahnmo Study Group and USAID/MaMoni Health Systems Strengthening (HSS) Project supported the MoHFW to operationalize the new guidelines and conducted an implementation research study in selected districts to assess challenges and identify solutions to facilitate scale-up across the country. IMPLEMENTATION SUPPORT Projahnmo and MaMoni HSS teams supported implementation in three areas: building capacity, strengthening service delivery, and mobilizing communities. Capacity building focused on training paramedics to conduct outpatient management of PSBI cases and developing monitoring and supervision systems. The teams also filled gaps in government supply of essential drugs, equipment, and logistics. Community mobilization strategies to promote care-seeking and referrals to facilities varied across districts; in one district community, health workers made home visits while in another district, the promotion was carried out through community volunteers, village doctors, and through existing community structures. METHODS We followed a plan-do-study-act (PDSA) cycle to identify and address implementation challenges. Three cycles-1 every 4 months-were conducted. We collected data utilizing quantitative and qualitative methods in both the community and facilities. The total sample size for this study was 13,590. DISCUSSION This article provides implementation research design details for program managers intending to implement new guidelines on management of young infant infections. Results of this research will be reported in the forthcoming papers. Preliminary findings indicate that the management of PSBI cases at the UH&FWCs is feasible. However, MoHFW, GOB needs to address the implementation challenges before scale-up of this policy to the national level.
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Affiliation(s)
| | - Jennifer A Applegate
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Dipak K Mitra
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229, Bangladesh
| | - Jennifer A Callaghan-Koru
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, MD, USA
| | | | | | - Taufique Joarder
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Meagan Harrison
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Sabbir Ahmed
- USAID's MaMoni Health Systems Strengthening Project, Save the Children, Washington, DC, USA
| | - Nazma Begum
- Johns Hopkins University-Bangladesh, Dhaka, 1213, Bangladesh
| | - Abdul Quaiyum
- Maternal and Child Health Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Joby George
- USAID's MaMoni Health Systems Strengthening Project, Save the Children, Washington, DC, USA
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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Chandrasekhar D, PokkaVayalil V. Cost minimization analysis on IV to oral conversion of antimicrobial agent by the clinical pharmacist intervention. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zhang S, Sammon PM, King I, Andrade AL, Toscano CM, Araujo SN, Sinha A, Madhi SA, Khandaker G, Yin JK, Booy R, Huda TM, Rahman QS, El Arifeen S, Gentile A, Giglio N, Bhuiyan MU, Sturm-Ramirez K, Gessner BD, Nadjib M, Carosone-Link PJ, Simões EA, Child JA, Ahmed I, Bhutta ZA, Soofi SB, Khan RJ, Campbell H, Nair H. Cost of management of severe pneumonia in young children: systematic analysis. J Glob Health 2018; 6:010408. [PMID: 27231544 PMCID: PMC4871066 DOI: 10.7189/jogh.06.010408] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health. METHODS We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non-severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate. RESULTS We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low- and-middle income countries (LMIC) and high-income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5-8.7), US$ 51.7 (95% CI 17.4-91.0) and US$ 242.7 (95% CI 153.6-341.4)-559.4 (95% CI 268.9-886.3) in community, out-patient facilities and different levels of hospital in-patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%-115.8% of patients' monthly household income in LMIC. The mean direct non-medical cost and indirect cost for severe pneumonia management accounted for 0.5-31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3-6.4) and 7.7 (IQR 5.5-9.9) days in LMIC and HIC respectively for these children. CONCLUSION This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.
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Affiliation(s)
- Shanshan Zhang
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Department of Preventive Dentistry, Peking University, School and Hospital of Stomatology, Beijing, PR China
| | - Peter M Sammon
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Isobel King
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; NHS Grampian, UK
| | | | | | - Sheila N Araujo
- Department of Community Health, Federal University of Goias, Brazil; State University of Maranhăo, Brazil
| | - Anushua Sinha
- New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey USA
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Gulam Khandaker
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Jiehui Kevin Yin
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Tanvir M Huda
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Qazi S Rahman
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Shams El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Angela Gentile
- Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina
| | - Norberto Giglio
- Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina
| | | | - Katharine Sturm-Ramirez
- Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh; Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mardiati Nadjib
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Phyllis J Carosone-Link
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA
| | - Eric Af Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Jason A Child
- Pharmacy Department, Children's Hospital Colorado, Aurora, CO, USA
| | - Imran Ahmed
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Sajid B Soofi
- Department of Paediatrics & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rumana J Khan
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India
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Blumer JL, Ghonghadze T, Cannavino C, O'Neal T, Jandourek A, Friedland HD, Bradley JS. A Multicenter, Randomized, Observer-blinded, Active-controlled Study Evaluating the Safety and Effectiveness of Ceftaroline Compared With Ceftriaxone Plus Vancomycin in Pediatric Patients With Complicated Community-acquired Bacterial Pneumonia. Pediatr Infect Dis J 2016; 35:760-6. [PMID: 27078119 DOI: 10.1097/inf.0000000000001160] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The broad-spectrum cephalosporin ceftaroline, a metabolite of the prodrug ceftaroline fosamil, has shown in vitro activity against clinical isolates from pediatric patients. METHODS This multicenter, randomized, observer-blinded, active-controlled study (NCT01669980) assessed the safety and effectiveness of ceftaroline fosamil compared with ceftriaxone plus vancomycin in patients between 2 months and 17 years of age with complicated community-acquired bacterial pneumonia. Patients were randomized 3:1 (stratified by age cohort) to receive either ceftaroline fosamil or ceftriaxone plus vancomycin (comparator) as intravenous therapy for ≥3 days. Patients who met specific study criteria on or after Study Day 4 were permitted to switch to an oral study drug. Safety assessments were treatment-emergent adverse events, and the effectiveness of treatment was assessed by clinical and microbiologic outcomes. RESULTS The median duration of intravenous treatment was 9.0 (range, 3.0-19.0) days in the ceftaroline fosamil group (N=30) and 7.5 (5.0-13.0) days in the comparator group (N=10). At least one treatment-emergent adverse event was experienced by 12/30 patients (40%) in the ceftaroline fosamil group and 8/10 (80%) in the comparator group; most treatment-emergent adverse events in both groups were mild to moderate in intensity. Clinical response rates in the modified intent-to-treat population were 52% (15/29 patients) in the ceftaroline fosamil group and 67% in the comparator group (6/9); clinical stability at Study Day 4 was 21% (6/29) and 22% (2/9), respectively. CONCLUSIONS Ceftaroline fosamil was well tolerated and showed similar clinical response rates to ceftriaxone plus vancomycin in pediatric patients with complicated community-acquired bacterial pneumonia.
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Affiliation(s)
- Jeffrey L Blumer
- From the *Toledo Children's Hospital, Toledo, Ohio; †Children's New Clinic, Tbilisi, Georgia; ‡University of California at San Diego and Rady Children's Hospital, San Diego, California; and §Cerexa, Inc., Oakland, California
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Aldeyab MA, Elshibly SM, McElnay JC, Davies E, Scott MG, Magee FA, Leyden P, Kearney MP. An Evaluation of Compliance with an Antibiotic Policy in Surgical Wards at a General Teaching Hospital in Northern Ireland. Infect Control Hosp Epidemiol 2015; 30:921-2. [DOI: 10.1086/599308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shrayteh ZM, Rahal MK, Malaeb DN. Practice of switch from intravenous to oral antibiotics. SPRINGERPLUS 2014; 3:717. [PMID: 25674457 PMCID: PMC4320166 DOI: 10.1186/2193-1801-3-717] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/20/2014] [Indexed: 11/23/2022]
Abstract
Hospitalized patients initially on intravenous antibiotics can be safely switched to an oral equivalent within the third day of admission once clinical stability is established. This conversion has many advantages as fewer complications, less healthcare costs and earlier hospital discharge. The three types of intravenous to oral conversion include sequential, switch, and step-down therapy. The aim of the study was to evaluate the practice of switching from intravenous to oral antibiotics, its types and its impact on the clinical outcomes. This was a retrospective observational study conducted in three Lebanese hospitals over a period of six months. Adult inpatients on intravenous antibiotics for 2 days and more were eligible for study enrollment. Excluded were patients admitted to care or surgery units, or those with gastrointestinal diseases, infections that require prolonged course of parenteral therapy, or malignancies. The study showed that among 452 intravenous antibiotic courses from 356 patients who were eligible for conversion, only one third were switched and the others continued on intravenous antibiotics beyond day 3 (P <0.0001). The mean duration of intravenous therapy of converted patients was markedly shorter than the non-converted (P <0.0001) with no significant change in the mean length of stay. Fluoroquinolones and macrolides were the most commonly converted antibiotics. However, the sequential therapy was the major type of conversion practiced in this study. Based on the study findings, a significant proportion of patients can be considered for switch. This emphasizes an important gap in the field of conversion from intravenous to oral antibiotic therapy and the need for integration and reinforcement of the appropriate Antibiotic Stewardship Programs in hospitals.
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Affiliation(s)
- Zeina M Shrayteh
- School of Pharmacy, Department of Clinical Pharmacy, Lebanese International University, Mazraa, 146404 Beirut, Lebanon
| | - Mohamad K Rahal
- School of Pharmacy, Department of Pharmaceutical Sciences, Lebanese International University, Mazraa, 146404 Beirut, Lebanon
| | - Diana N Malaeb
- School of Pharmacy, Department of Clinical Pharmacy, Lebanese International University, Mazraa, 146404 Beirut, Lebanon
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Maripuu H, Aldeyab MA, Kearney MP, McElnay JC, Conlon G, Magee FA, Scott MG. An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sallach-Ruma R, Phan C, Sankaranarayanan J. Evaluation of outcomes of intravenous to oral antimicrobial conversion initiatives: a literature review. Expert Rev Clin Pharmacol 2014; 6:703-29. [DOI: 10.1586/17512433.2013.844647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Safety and efficacy of simplified antibiotic regimens for outpatient treatment of serious infection in neonates and young infants 0-59 days of age in Bangladesh: design of a randomized controlled trial. Pediatr Infect Dis J 2013; 32 Suppl 1:S12-8. [PMID: 23945570 PMCID: PMC3815010 DOI: 10.1097/inf.0b013e31829ff790] [Citation(s) in RCA: 17] [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] [Indexed: 11/30/2022]
Abstract
BACKGROUND Because access to care is limited in settings with high mortality, exclusive reliance on the current recommendation of 7-10 days of parenteral antibiotic treatment is a barrier to provision of adequate treatment of newborn infections. METHODS We are conducting a trial to determine if simplified antibiotic regimens with fewer injections are as efficacious as the standard course of parenteral antibiotics for empiric treatment of young infants with clinical signs suggestive of severe infection in 4 urban hospitals and in a rural surveillance site in Bangladesh. The reference regimen of intramuscular procaine-benzyl penicillin and gentamicin given once daily for 7 days is being compared with (1) intramuscular gentamicin once daily and oral amoxicillin twice daily for 7 days and (2) intramuscular penicillin and gentamicin once daily for 2 days followed by oral amoxicillin twice daily for additional 5 days. All regimens are provided in the infant's home. The primary outcome is treatment failure (death or lack of clinical improvement) within 7 days of enrolment. The sample size is 750 evaluable infants enrolled per treatment group, and results will be reported at the end of 2013. DISCUSSION The trial builds upon previous studies of community case management of clinical severe infections in young infants conducted by our research team in Bangladesh. The approach although effective was not widely accepted in part because of feasibility concerns about the large number of injections. The proposed research that includes fewer doses of parenteral antibiotics if shown efficacious will address this concern.
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Abstract
BACKGROUND Pneumonia caused by bacterial pathogens is the leading cause of mortality in children in low-income countries. Early administration of antibiotics improves outcomes. OBJECTIVES To identify effective antibiotic drug therapies for community-acquired pneumonia (CAP) of varying severity in children by comparing various antibiotics. SEARCH METHODS We searched CENTRAL 2012, Issue 10; MEDLINE (1966 to October week 4, 2012); EMBASE (1990 to November 2012); CINAHL (2009 to November 2012); Web of Science (2009 to November 2012) and LILACS (2009 to November 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) in children of either sex, comparing at least two antibiotics for CAP within hospital or ambulatory (outpatient) settings. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the full articles of selected studies. MAIN RESULTS We included 29 trials, which enrolled 14,188 children, comparing multiple antibiotics. None compared antibiotics with placebo.Assessment of quality of study revealed that 5 out of 29 studies were double-blind and allocation concealment was adequate. Another 12 studies were unblinded but had adequate allocation concealment, classifying them as good quality studies. There was more than one study comparing co-trimoxazole with amoxycillin, oral amoxycillin with injectable penicillin/ampicillin and chloramphenicol with ampicillin/penicillin and studies were of good quality, suggesting the evidence for these comparisons was of high quality compared to other comparisons.In ambulatory settings, for treatment of World Health Organization (WHO) defined non-severe CAP, amoxycillin compared with co-trimoxazole had similar failure rates (odds ratio (OR) 1.18, 95% confidence interval (CI) 0.91 to 1.51) and cure rates (OR 1.03, 95% CI 0.56 to 1.89). Three studies involved 3952 children.In children with severe pneumonia without hypoxaemia, oral antibiotics (amoxycillin/co-trimoxazole) compared with injectable penicillin had similar failure rates (OR 0.84, 95% CI 0.56 to 1.24), hospitalisation rates (OR 1.13, 95% CI 0.38 to 3.34) and relapse rates (OR 1.28, 95% CI 0.34 to 4.82). Six studies involved 4331 children below 18 years of age.In very severe CAP, death rates were higher in children receiving chloramphenicol compared to those receiving penicillin/ampicillin plus gentamicin (OR 1.25, 95% CI 0.76 to 2.07). One study involved 1116 children. AUTHORS' CONCLUSIONS For treatment of patients with CAP in ambulatory settings, amoxycillin is an alternative to co-trimoxazole. With limited data on other antibiotics, co-amoxyclavulanic acid and cefpodoxime may be alternative second-line drugs. Children with severe pneumonia without hypoxaemia can be treated with oral amoxycillin in an ambulatory setting. For children hospitalised with severe and very severe CAP, penicillin/ampicillin plus gentamycin is superior to chloramphenicol. The other alternative drugs for such patients are co-amoxyclavulanic acid and cefuroxime. Until more studies are available, these can be used as second-line therapies.There is a need for more studies with radiographically confirmed pneumonia in larger patient populations and similar methodologies to compare newer antibiotics. Recommendations in this review are applicable to countries with high case fatalities due to pneumonia in children without underlying morbidities and where point of care tests for identification of aetiological agents for pneumonia are not available.
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Affiliation(s)
- Rakesh Lodha
- All India Institute of Medical SciencesDepartment of PediatricsAnsari NagarNew DelhiIndia110029
| | - Sushil K Kabra
- All India Institute of Medical SciencesPediatric Pulmonology Division, Department of PediatricsAnsari NagarNew DelhiIndia110029
| | - Ravindra M Pandey
- All India Institute of Medical Sciences (AIIMS)Department of BiostatisticsAnsari NagarNew DelhiIndia110029
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Jones M, Huttner B, Madaras-Kelly K, Nechodom K, Nielson C, Bidwell Goetz M, Neuhauser MM, Samore MH, Rubin MA. Parenteral to oral conversion of fluoroquinolones: low-hanging fruit for antimicrobial stewardship programs? Infect Control Hosp Epidemiol 2012; 33:362-7. [PMID: 22418631 DOI: 10.1086/664767] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate avoidable intravenous (IV) fluoroquinolone use in Veterans Affairs (VA) hospitals. DESIGN A retrospective analysis of bar code medication administration (BCMA) data. SETTING Acute care wards of 128 VA hospitals throughout the United States. METHODS Data were analyzed for all medications administered on acute care wards between January 1, 2006, and December 31, 2010. Patient-days receiving therapy were expressed as fluoroquinolone-days (FD) and divided into intravenous (IV; all doses administered intravenously) and oral (PO; at least one dose administered per os) FD. We assumed IV fluoroquinolone use to be potentially avoidable on a given IV FD when there was at least 1 other medication administered via the enteral route. RESULTS Over the entire study period, 884,740 IV and 830,572 PO FD were administered. Overall, avoidable IV fluoroquinolone use accounted for 46.8% of all FD and 90.9% of IV FD. Excluding the first 2 days of all IV fluoroquinolone courses and limiting the analysis to the non-ICU setting yielded more conservative estimates of avoidable IV use: 20.9% of all FD and 45.9% of IV FD. Avoidable IV use was more common for levofloxacin and more frequent in the ICU setting. There was a moderate correlation between avoidable IV FD and total systemic antibiotic use (r = 0.32). CONCLUSIONS Unnecessary IV fluoroquinolone use seems to be common in the VA system, but important variations exist between facilities. Antibiotic stewardship programs could focus on this patient safety issue as a "low-hanging fruit" to increase awareness of appropriate antibiotic use.
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Affiliation(s)
- Makoto Jones
- IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, Utah 84148, USA.
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Abstract
BACKGROUND Pneumonia caused by bacterial pathogens is the leading cause of mortality in children in low-income countries. Early administration of antibiotics improves outcomes. OBJECTIVES To identify effective antibiotics for community acquired pneumonia (CAP) in children by comparing various antibiotics. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1966 to September 2009); and EMBASE (1990 to September 2009). SELECTION CRITERIA Randomised controlled trials (RCTs) in children of either sex, comparing at least two antibiotics for CAP within hospital or ambulatory (outpatient) settings. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from full articles of selected studies. MAIN RESULTS There were 27 studies, which enroled 11,928 children, comparing multiple antibiotics. None compared antibiotic with placebo.For ambulatory treatment of non-severe CAP, amoxycillin compared with co-trimoxazole had similar failure rates (OR 0.92; 95% CI 0.58 to 1.47) and cure rates (OR 1.12; 95% CI 0.61 to 2.03). (Three studies involved 3952 children).In children hospitalised with severe CAP, oral amoxycillin compared with injectable penicillin or ampicillin had similar failure rates (OR 0.95; 95% CI 0.78 to 1.15). (Three studies involved 3942 children). Relapse rates were similar in the two groups (OR 1.28; 95% CI 0.34 to 4.82).In very severe CAP, death rates were higher in children receiving chloramphenicol compared to those receiving penicillin/ampicillin plus gentamycin (OR 1.25; 95% CI 0.76 to 2.07). (One study involved 1116 children). AUTHORS' CONCLUSIONS There were many studies with different methodologies investigating multiple antibiotics. For treatment of ambulatory patients with CAP, amoxycillin is an alternative to co-trimoxazole. With limited data on other antibiotics, co-amoxyclavulanic acid and cefpodoxime may be alternative second-line drugs. For severe pneumonia without hypoxia, oral amoxycillin may be an alternative to injectable penicillin in hospitalised children; however, for ambulatory treatment of such patients with oral antibiotics, more studies in community settings are required. For children hospitalised with severe and very severe CAP, penicillin/ampicillin plus gentamycin is superior to chloramphenicol. The other alternative drugs for such patients are ceftrioxone, levofloxacin, co-amoxyclavulanic acid and cefuroxime. Until more studies are available, these can be used as a second-line therapy.There is a need for more studies with larger patient populations and similar methodologies to compare newer antibiotics.
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Affiliation(s)
- Sushil K Kabra
- Pediatric Pulmonology Division, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
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14
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Van Gastel E, Costers M, Peetermans WE, Struelens MJ. Nationwide implementation of antibiotic management teams in Belgian hospitals: a self-reporting survey. J Antimicrob Chemother 2010; 65:576-80. [PMID: 20053695 DOI: 10.1093/jac/dkp470] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Antibiotic management teams (AMTs) have been advocated to optimize the use of antimicrobials in hospitals. Since 2002, the Belgian Antibiotic Policy Coordination Committee (BAPCOC) has supported the development of AMTs in Belgian hospitals with policy guidance and federal funding for antibiotic managers. We performed a national, self-reporting survey to assess the level of AMT activities in 2007. METHODS A structured questionnaire survey was performed on the composition, organization and service activities of the AMT in all acute care and larger chronic care hospitals in the country in 2007. Descriptive statistics were stratified by duration of AMT funding. RESULTS Completed questionnaires were provided by 112 of 116 hospitals (response rate, 96.6%). Mutidisciplinary AMTs varied in size (mean 10, range 2-28 members). Antibiotic stewardship tools used by AMTs included: hospital antibiotic formulary (96.3% of hospitals); practice guidelines for antibiotic therapy and surgical prophylaxis (91.6% and 96.3%, respectively); list of 'restricted' antimicrobial agents (75.9%); concurrent review of antibiotic therapies (64.2%); de-escalation of therapy after a few days (63.9%); sequential intravenous/oral therapy for antibiotics with equivalent bioavailability (78.7%); dedicated antimicrobial order forms (36.1%); automatic stop of delivery (43.5%); analysis of antibiotic consumption data (96.2%); and analysis of microbial resistance data (89.8%). CONCLUSIONS These data demonstrate a well-developed structure of AMTs in Belgian hospitals and the broad range of services provided. Technical and financial support by healthcare authorities was key to the extensive implementation of antimicrobial stewardship programmes across the national hospital care system.
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Affiliation(s)
- Evelyne Van Gastel
- Belgian Antibiotic Policy Coordination Committee (BAPCOC), Federal Public Service Health, Food Chain Safety and Environment, Victor Horta plein 40/10, 1060 Brussels, Belgium.
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Atkinson M, Yanney M, Stephenson T, Smyth A. Effective treatment strategies for paediatric community-acquired pneumonia. Expert Opin Pharmacother 2007; 8:1091-101. [PMID: 17516873 PMCID: PMC7103692 DOI: 10.1517/14656566.8.8.1091] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pneumonia is the leading cause of death in children under 5 years of age worldwide and a cause of morbidity in a considerable number of children. A number of studies have sought to identify the ideal choice of antibiotics, route of administration and optimum duration of treatment based on the most likely aetiological agents. Emerging bacterial resistance to antibiotics is also an important consideration in treatment. However, inconsistent clinical and radiological definitions of pneumonia make comparison between studies difficult. There is also a lack of well designed adequately powered randomised controlled trials. This review describes the difficulties encountered in diagnosing community-acquired pneumonia, aetiology, treatment strategies with recommendations and highlights areas for further research.
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Affiliation(s)
- Maria Atkinson
- Specialist Registrar, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael Yanney
- Specialist Registrar, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Terence Stephenson
- Professor of Child Health, Division of Child Health, University of Nottingham, Nottingham, UK
| | - Alan Smyth
- Senior Lecturer in Child Health, Division of Respiratory Medicine, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2006; 44:159-77. [PMID: 17173212 DOI: 10.1086/510393] [Citation(s) in RCA: 2290] [Impact Index Per Article: 127.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 10/04/2006] [Indexed: 12/31/2022] Open
Affiliation(s)
- Timothy H Dellit
- Harborview Medical Center and the University of Washington, Seattle, USA
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Abstract
BACKGROUND Pneumonia is the leading cause of mortality in children. In developing countries, pneumonia is usually caused by bacterial pathogens. The early administration of empirical antibiotics improves the patients' clinical outcomes. There are currently no systematic reviews of clinical trials on this subject. OBJECTIVES To identify effective antibiotic drug therapy for community acquired pneumonia (CAP) in children by comparing various antibiotics. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2005), MEDLINE (OVID) (1966 to January 2006) and EMBASE (WebSPIRS) (1990 to September 2005). There were no language restrictions. SELECTION CRITERIA Randomized controlled trials (RCTs) in children of either sex, which compared at least two antibiotics for CAP in hospital or ambulatory settings. DATA COLLECTION AND ANALYSIS Data from full articles of selected studies were independently extracted by two authors. MAIN RESULTS The review of these studies suggests that for treatment of pneumonia, co-trimoxazole is inferior in efficacy to both amoxycillin (failure rates odds ratio (OR) 1.33; 95% CI 1.05 to 1.67) and procaine penicillin (cure rates OR 2.64; 95% CI 1.57 to 4.45). Penicillin in conjunction with gentamycin was better than chloramphenicol alone (re-hospitalization rates OR 1.61; 95% CI 1.02 to 2.55). Co-amoxyclavulanic acid was better than amoxycillin alone (cure rates OR 10.44; 95% CI 2.85 to 38.21). There was no differences between injectable penicillin and oral amoxycillin (failure rates OR 1.03; 95% CI 0.81 to 1.31); azithromycin and erythromycin (cure rates OR 1.17; 95% CI 0.70 to 1.95); cefpodoxime and amoxycillin (cure rates OR 0.69; 95% CI 0.18 to 2.60); or azithromycin and co-amoxyclavulanic acid (cure rates OR 1.02; 95% CI 0.54 to 1.95, failure rates OR 1.42; 95% CI 0.43 to 4.66). AUTHORS' CONCLUSIONS There were many studies each investigating multiple antibiotics with different methodologies. For treatment of ambulatory patients with CAP, amoxycillin was better than co-trimoxazole; there was no difference between azithromycin and erythromycin, or between cefpodoxime and co-amoxyclavulanic acid. For hospitalized patients, procaine penicillin was better than co-trimoxazole; and the combination of penicillin and gentamycin was better than chloramphenicol alone. Injectable penicillin and oral amoxycillin had similar failure rates. For the rest of the antibiotics there were only single studies available. There is a need for more studies with large patient populations and similar methodologies in order to compare newer antibiotics.
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Affiliation(s)
- S K Kabra
- All India Institute of Medical Sciences, Department of Pediatrics, Ansari Nagar, New Delhi, India 110 029.
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18
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Abstract
BACKGROUND Acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality in children under five years of age in developing countries. When hospitalisation is required, the usual practice includes administering parenteral antibiotics if a bacterial infection is suspected. This has disadvantages as it causes pain and discomfort to the children, which may lead to treatment refusal or reduced compliance. It is also associated with needle-related complications. In some settings this equipment is in short supply or unavailable necessitating transfer of the child, which increases risks and healthcare costs. OBJECTIVES To determine the equivalence in effectiveness and safety of oral antibiotic compared to parenteral antibiotic therapies in the treatment of severe pneumonia in children between three months and five years of age. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005); MEDLINE (January 1966 to July 2005); EMBASE (January 1990 to July 2005) and LILACS (February 2005). SELECTION CRITERIA The review included published or unpublished randomised controlled trials (RCTs) and quasi-RCTs comparing any oral antibiotic therapy with any parenteral antibiotic therapy for the treatment of severe pneumonia in children from three months to five years of age. DATA COLLECTION AND ANALYSIS The search yielded more than 1300 titles. Only three studies met all criteria for eligibility. One of the identified trials is yet to publish its results. We did not perform a meta-analysis because of clinical heterogeneity of therapies compared in the included trials. MAIN RESULTS Campbell 1988 compared oral co-trimoxazole versus intramuscular procaine penicillin followed by oral ampicillin in 134 children. At the seventh day of follow up, treatment failure occurred in 6/66 (9.1%) in the oral co-trimoxazole group and 7/68 (10.2%) in the combined-treatment group. The risk difference was -0.01% (95% confidence interval (CI) -0.11 to 0.09). The APPIS Group 2004 evaluated 1702 patients comparing oral amoxicillin versus intravenous penicillin for two days followed by oral amoxicillin. After 48 hours, treatment failure occurred in 161/845 (19%) in the amoxicillin group and 167/857 (19%) in the parenteral penicillin group. The risk difference was -0.4% (95% CI -4.2 to 3.3). The authors reported similar recovery in both groups at 5 and 14 days. AUTHORS' CONCLUSIONS Oral therapy appears to be an effective and safe alternative to parenteral antibiotics in hospitalised children with severe pneumonia who do not have any serious signs or symptoms.
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Affiliation(s)
- M X Rojas
- Pontificia Universidad Javeriana, Epidemiology Unit, Faculty of Medicine, Hospital Universitario de San Ignacio, Cr. 7 #40-62, 2nd floor, Bogota, DC, Colombia.
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Abstract
Studies conducted over the past few years for the treatment of pneumonia have provided data on the basis of which therapeutic decisions concerning the duration of therapy can be taken. Results from a majority of the studies conducted in hospitalised patients using the conventional methods for diagnosing pneumonia have methodological problems, which make it difficult to draw definite conclusions. Despite these limitations, the overall trend of these descriptive studies show a therapy of < or =5 days being as effective as the longer course of 7-14 days for children up to the age of 12 years. Data for duration of antibacterial therapy for infants <2 months of age hardly exists. Evidence suggests that a shorter course of antibacterial therapy of 3 days is effective for treatment of community-acquired, non-severe ambulatory pneumonia in immunocompetent children aged 2-59 months old. Shorter duration of therapy offers several potential advantages that include prevention of the emergence of antimicrobial resistance, lower healthcare costs, improved adherence to therapy and fewer adverse effects. There is a need to improve the evidence base for the optimum duration of therapy for children hospitalised with severe pneumonia.
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Affiliation(s)
- Shamim Qazi
- Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland.
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20
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Abstract
The use of inadequate empirical antimicrobial therapy is common in intensive care unit patients and contributes to a number of poor outcomes. Selecting appropriate antimicrobial therapy is complicated by many factors, including the large number of agents available, the presence of resistant organisms, and the general desire among practitioners to use the most focused therapy available. An important aspect of appropriate antimicrobial use is prompt initiation of adequate empirical therapy, which has been shown to improve mortality rates in hospitalized patients with pneumonia and other serious infections. Other key strategies include streamlining antimicrobial therapy when a pathogen is identified and switching from intravenous to oral therapy when clinically indicated. In addition, antibiotic rotation (or cycling) has been evaluated in several trials as a means to minimize resistance. Promoting appropriate antimicrobial therapy ultimately will require a multidisciplinary, system-oriented, institution-specific approach because each intensive care unit has its own unique flora and antimicrobial resistance patterns.
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Affiliation(s)
- Michael S Niederman
- Pulmonary and Critical Care Medicine, Winthrop University Hospital, Mineola, NY, USA
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Di Ciommo V, Russo P, Attanasio E, Di Liso G, Graziani C, Caprino L. Clinical and economic outcomes of pneumonia in children: a longitudinal observational study in an Italian paediatric hospital. J Eval Clin Pract 2002; 8:341-8. [PMID: 12164981 DOI: 10.1046/j.1365-2753.2002.00351.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Antibiotic prescription for acute lower respiratory infections (ALRI) in hospitalized children can have a major impact on cure and costs. We performed a longitudinal study to explore the appropriateness of prescriptions, the predictors of therapeutic patterns, and the main outcomes: readmission, length of stay (LOS) and costs. METHODS Ninety-nine children who were inpatients of a paediatric hospital receiving antibiotic treatment for community acquired ALRI were consecutively enrolled. To calculate the costs of pneumonia treatment, we collected data on clinical presentation and resources consumption. We used multiple regression analysis to identify predictors of LOS and choice of therapy, and one-way ANOVA to evaluate cost differences among treatment groups. RESULTS Parenteral antibiotics were administered in 64.6% of cases, whereas 35.4% received oral antibiotic therapy by itself (OAT). Switch therapy (SWT) was performed in 43.4% of cases. The most frequently prescribed antibiotic for parenteral therapy was ceftriaxone (58.3%), and for oral therapy cefprozil (58.1%). The median LOS was 3 days and the cure rate 99% (95%CI: 97-100%). SWT and OAT were significantly associated with a shorter LOS. The clinical variables were not significantly associated with SWT or OAT. The average costs per patient in the management of pneumonia were Euro 1435. SWT or OAT were associated with significant lower costs: Euro 1487 per patient (95%CI: 1395-1580) and Euro 1335 per patient (95%CI: 1233-1437), respectively. CONCLUSIONS The hospital management of paediatric pneumonia was more influenced by the early discharge policy than by clinical variables without under-cure.
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Affiliation(s)
- V Di Ciommo
- Epidemiology Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
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Bradley JS. Management of community-acquired pediatric pneumonia in an era of increasing antibiotic resistance and conjugate vaccines. Pediatr Infect Dis J 2002; 21:592-8; discussion 613-4. [PMID: 12182396 DOI: 10.1097/00006454-200206000-00035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The antibiotic management of infants and children with pneumonia is based on the clinician's assessment of the most likely infecting pathogens, the susceptibilities of the infecting pathogens and the seriousness of the illness. The bacterial etiology of pneumonia changed significantly following the universal use of protein-conjugated vaccines for Haemophilus influenzae type b. Similar significant changes are likely to occur with universal use of protein-conjugated vaccines for Streptococcus pneumoniae, requiring the clinician to alter assumptions of the risk of invasive bacterial infection in the child who presents with pneumonia. New strategies are likely to require fewer ancillary tests (e.g. white blood cell count, C-reactive protein and blood culture) and suggest a decreased need for empiric antibiotic therapy. Although the majority of lower respiratory tract infections in children have a viral etiology and are not amenable to antibiotic therapy, for the seriously ill child who is thought to be likely to have pneumonia caused by a bacterial pathogen, recent changes in the susceptibility patterns of both common organisms such as S. pneumoniae and more unusual pulmonary pathogens such as Staphylococcus aureus have forced changes in the selection of both empiric and definitive antibiotic therapy. Third generation cephalosporins ceftriaxone and cefotaxime appear to be effective therapy for pneumonia caused by virtually all current isolates of S. pneumoniae. In contrast antibiotic regimens for life-threatening pulmonary infections in which Staphylococcus aureus is a suspected pathogen should include vancomycin.
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Affiliation(s)
- John S Bradley
- Division of Infectious Diseases, Children's Hospital, San Diego, CA, USA
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Lelekis M, Gould IM. Sequential antibiotic therapy for cost containment in the hospital setting: why not? J Hosp Infect 2001; 48:249-57. [PMID: 11461124 DOI: 10.1053/jhin.2001.1006] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Antibiotic cost represents a significant part of hospital budgets all over the world. Restriction policies, however and other similar programmes intervening in antimicrobial prescribing have not always been successful in lowering antibiotic expenditure. Timely switch or sequential therapy from initial intravenous to subsequent equivalent oral treatment has been implemented in many institutions for the same purpose. Using strict criteria for optimum patient selection, switch therapy has been proven both effective as antimicrobial treatment and cost saving. As healthcare resources remain lower than needed, cost-saving policies become very desirable. Thus, switch therapy is expected to be more widely used, since it is a cost containing policy which does not compromise treatment outcome.
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Affiliation(s)
- M Lelekis
- Special Infections Unit, The General Hospital of Athens "G. Gennimatas", Greece
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