Antibiotic prescribing pattern in paediatric in patients with first time wheezing

Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment.

Costs of Respiratory Syncytial Virus Hospitalizations in Colombia

BACKGROUND

Several clinical practice guidelines exist for the management of respiratory syncytial virus (RSV) infection, but the use and overuse of medications and medical tests with insufficient evidence of effectiveness remains substantial.

OBJECTIVE

This study aimed to evaluate the medical costs associated with bronchiolitis hospitalizations caused by RSV infection among infants aged < 2 years in Colombia.

METHODS

This was a prevalence-based cost-of-illness multicentric study performed from the societal perspective during 2016-2017. A case was defined as a laboratory-confirmed RSV infection with hospitalization. All costs and use of resources were collected directly from medical invoices and health records.

RESULTS

This study included 193 patients with a diagnosis of RSV. The average hospital stay duration was 5.55 days. The major contributors to hospitalization costs were room costs (31.5%), drugs (21.8%), and indirect costs (14.9%). Medications with the highest costs were nebulization with a hypertonic solution and systemic antibiotics. In total, 96% of β-lactam antibiotics, 90% of bronchodilators, and 86% of corticosteroids and epinephrine were classified as inappropriate.

CONCLUSION

RSV infection in Colombia places a high economic burden on the health system. Generating comprehensive data on healthcare resource use and costs associated with RSV will help to provide valuable information for the development of cost-effectiveness models and to guide RSV-prevention strategies.

Inappropriate antibiotic prescribing for acute bronchiolitis in Colombia: a predictive model

Introduction

Acute bronchiolitis is the leading cause of hospitalization in the pediatric population. The inappropriate prescription of antibiotics in acute bronchiolitis is associated with bacterial resistance, higher costs, and risk of adverse effects in this population. The objective of this work is to develop a predictive model of inappropriate use of antibiotics in children with acute bronchiolitis in Colombia.

Methods

A retrospective cohort study was conducted in patients under 2 years of age with a diagnosis of acute bronchiolitis from two hospitals in Rionegro, Colombia. To identify factors independently associated with inappropriate use of antibiotics, we used logistic regression and estimated odds ratios (ORs). To assess discrimination, area under the curve (AUC) was estimated with a 95% confidence interval and plotted using AUC–ROC plots. To correct sampling bias of variance parameters and to evaluate the internal validity of the model, repeated curved validation “tenfold cross-validation” was used, comparing the area under the ROC curve obtained in the repetitions with that observed in the model

Results

A total of 415 patients were included. 142 patients (34.13%) had a prescription of some antibiotic during their hospital stay. In 92 patients (64.78%, 95% CI 56.3 to 72.6%) the prescription of antibiotics was classified as inappropriate. Age older than 1 year, chest retractions, temperature between 37.5 °C and 38.5 °C and leukocyte count between 10,000 and 15,000 million/mm³ were the predictive variables of inappropriate use of medications in this population.

Conclusion

The presence of fever between 37.5 °C and 38.5 °C, leukocytosis between 10,000 and 15,000 million/mm³, and age older than 1 year and presence of chest retractions, should alert the physician regarding the high risk of inappropriate prescription of antibiotics. Patients with acute bronchiolitis with a score on our scale greater than 2 should be carefully evaluated regarding the need for the use of antibiotics, if prescribed.

Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification: a study of 12 physicians' classification of lung sounds from video recordings

Background

The European Respiratory Society (ERS) lung sounds repository contains 20 audiovisual recordings of children and adults. The present study aimed at determining the interobserver variation in the classification of sounds into detailed and broader categories of crackles and wheezes.

Methods

Recordings from 10 children and 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 doctors for adult patients. Multirater kappa (Fleiss' κ) was calculated for each of the 10 adventitious sounds and for combined categories of sounds.

Results

The majority of observers agreed on the presence of at least one adventitious sound in 17 cases. Poor to fair agreement (κ<0.40) was usually found for the detailed descriptions of the adventitious sounds, whereas moderate to good agreement was reached for the combined categories of crackles (κ=0.62) and wheezes (κ=0.59). The paediatricians did not reach better agreement on the child cases than the family physicians and specialists in adult medicine.

Conclusions

Descriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions.