Allergy to antibiotics in children: Perception versus reality

Perceptions and reported practices of pregnant women and mothers of children under two years of age regarding antibiotic use and resistance in Vientiane province, Lao PDR: a qualitative study

BACKGROUND

Understanding pregnant women and mothers' perceptions towards antibiotic use and resistance is essential for appropriate antibiotic use and limiting antibiotic resistance. This study aimed to explore perceptions and reported practices of pregnant women and mothers with children under two years of age regarding correct antibiotic use and antibiotic resistance in Vientiane Province, Lao PDR.

METHODS

The study employed an exploratory qualitative research design using focus groups discussions (FGDs). Participants were purposively selected based on: being pregnant at third trimester and attending antenatal care and mothers with children under two years of age, attending the health facility for postpartum visit /vaccinations. Six focus group discussions were conducted in September 2019 with a total of 55 women. The FGDs were transcribed verbatim, data were analyzed first by coding then categorizing the data as we looked for patterns and themes by using the qualitative content analysis.

RESULTS

Most participants had some understanding of antibiotics but wrongly believed antibiotics can be used to treat viral disease. Over half of the participants had heard the term "antibiotic resistance", but often believed it was their bodies, not the bacteria that developed antibiotic resistance. During pregnancy and for their infants, women preferred to use antibiotics only when prescribed by a doctor. Outside of pregnancy however, consuming antibiotics without a prescription was commonly reported. Participants wanted more information about the indications for antibiotic use and antibiotic resistance.

CONCLUSIONS

More effort is required to increase the level of understanding, and practice of mothers to promote optimal antibiotic use. Mothers' desire to learn more, and their fundamental concern for their children, can be used to promote appropriate antibiotic use. Awareness raising should be complemented by efforts to address other determinants of inappropriate antibiotic use, including educating healthcare workers, and pharmacists and addressing health service determinants that contribute to inappropriate antibiotic use.

Non-β-Lactam Antibiotic Hypersensitivity Reactions

OBJECTIVES

Antibiotics are among the most common prescriptions in children, and non-β-lactam antibiotics (NBLAs) account for almost half of those prescribed in Australian pediatric hospitals. Despite this, data on NBLA hypersensitivity in children are limited. This study describes reported hypersensitivity reactions to NBLAs in children and the results of allergy evaluation.

METHODS

Children with a suspected NBLA allergy who had skin testing and/or an intravenous or oral challenge test (OCT) between May 2011 and June 2018 were included. Patients were excluded if they were >18 years old or did not complete the allergy evaluation for any reason other than allergic reaction.

RESULTS

Over the 7-year study period, 141 children had 150 allergy evaluations of 15 different NBLAs. The median time from the initial reported reaction to allergy evaluation was 1.9 (range 0.1-14.9) years. Overall, 27 of the 150 (18.0%) challenge tests to NBLAs had positive results, with the rate of positive OCT results being highest for trimethoprim-sulfamethoxazole (15 of 46; 32.6%) and macrolides (8 of 77; 10.4%). Although 4 children reported initial anaphylactic reactions, no patients had severe symptoms on rechallenge or required adrenaline. Of the challenges that had positive results, the majority of children (23 of 27; 85.2%) had symptoms on repeat challenge similar to those that were initially reported.

CONCLUSIONS

Overall, 8 of 10 children with NBLA allergy could be delabeled. On average, patients waited 1.9 years to be rechallenged. Timely access to allergy evaluation to delabel these patients is needed to preserve first-line antibiotics.

Diagnosis of drug hypersensitivity in children and adolescents: discrepancy between physician-based assessment and results of testing

BACKGROUND

Diagnosis of drug hypersensitivity is often based on history alone. But such a vague diagnosis may cause limitations of therapeutic options in the future. To confirm or rule out drug hypersensitivity, skin testing, in vitro studies, and challenge tests are necessary. However, the diagnostic value of this complex and time-consuming allergologic work-up, especially in children, remains controversial.

OBJECTIVE

Aim of this retrospective analysis was to compare the results of diagnostic testing in children and adolescents with drug hypersensitivity diagnosed on clinical grounds, i.e., temporal relationship and observation of symptoms alone.

METHODS

We studied 43 children and adolescents (23 females, 20 males, mean age 13) with a history of immediate or delayed hypersensitivity symptoms in temporal relation to drug treatment using standardized skin testing followed by oral challenges. Patients with suspected penicillin hypersensitivity were further evaluated with in vitro tests.

RESULTS

Drug hypersensitivity was excluded in 40 patients by tolerated oral challenge tests with the incriminated drug. In two patients, positive challenge tests confirmed non-steroidal anti-inflammatory drug hypersensitivity. One patient with amoxicillin-associated exanthema developed positive late skin test reactions to aminopenicillins.

CONCLUSION

In childhood and adolescence, allergologic testing in cases of suspected drug hypersensitivity is of importance both to establish a correct diagnosis and to prevent unjustified withholding of a drug or class of drugs.