1
|
Algburi AR, Jassim SM, Popov IV, Weeks R, Chikindas ML. Lactobacillus acidophilus VB1 co-aggregates and inhibits biofilm formation of chronic otitis media-associated pathogens. Braz J Microbiol 2024; 55:2581-2592. [PMID: 38789905 PMCID: PMC11405553 DOI: 10.1007/s42770-024-01363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
This study aims to evaluate the antibacterial activity of Lactobacillus acidophilus, alone and in combination with ciprofloxacin, against otitis media-associated bacteria. L. acidophilus cells were isolated from Vitalactic B (VB), a commercially available probiotic product containing two lactobacilli species, L. acidophilus and Lactiplantibacillus (formerly Lactobacillus) plantarum. The pathogenic bacterial samples were provided by Al-Shams Medical Laboratory (Baqubah, Iraq). Bacterial identification and antibiotic susceptibility testing for 16 antibiotics were performed using the VITEK2 system. The minimum inhibitory concentration of ciprofloxacin was also determined. The antimicrobial activity of L. acidophilus VB1 cell-free supernatant (La-CFS) was evaluated alone and in combination with ciprofloxacin using a checkerboard assay. Our data showed significant differences in the synergistic activity when La-CFS was combined with ciprofloxacin, in comparison to the use of each compound alone, against Pseudomonas aeruginosa SM17 and Proteus mirabilis SM42. However, an antagonistic effect was observed for the combination against Staphylococcus aureus SM23 and Klebsiella pneumoniae SM9. L. acidophilus VB1 was shown to significantly co-aggregate with the pathogenic bacteria, and the highest co-aggregation percentage was observed after 24 h of incubation. The anti-biofilm activities of CFS and biosurfactant (BS) of L. acidophilus VB1 were evaluated, and we found that the minimum biofilm inhibitory concentration that inhibits 50% of bacterial biofilm (MBIC50) of La-CFS was significantly lower than MBIC50 of La-BS against the tested pathogenic bacterial species. Lactobacillus acidophilus, isolated from Vitane Vitalactic B capsules, demonstrated promising antibacterial and anti-biofilm activities against otitis media pathogens, highlighting its potential as an effective complementary/alternative therapeutic strategy to control bacterial ear infections.
Collapse
Affiliation(s)
- Ammar R Algburi
- Department of Microbiology, Veterinary Medicine College, University of Diyala, Baqubah, Iraq
| | - Shireen M Jassim
- Alkhalis Section for Primary Care/Thoracic and Respiratory Diseases Unit, Alkhalis, Iraq
| | - Igor V Popov
- Centre for Healthy Eating and Food Innovation, Maastricht University-Campus Venlo, Venlo, The Netherlands.
- Agrobiotechnology Center and Faculty "Bioengineering and Veterinary Medicine", Don State Technical University, Rostov-On-Don, Russia.
- Division of Immunobiology and Biomedicine, Center of Genetics and Life Sciences, Federal Territory Sirius, Sirius University of Science and Technology, Sochi, Russian Federation.
| | - Richard Weeks
- Health Promoting Naturals Laboratory, School of Environmental and Biological Sciences, Rutgers State University, New Brunswick, NJ, USA
| | - Michael L Chikindas
- Agrobiotechnology Center and Faculty "Bioengineering and Veterinary Medicine", Don State Technical University, Rostov-On-Don, Russia
- Health Promoting Naturals Laboratory, School of Environmental and Biological Sciences, Rutgers State University, New Brunswick, NJ, USA
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
2
|
Merenstein DJ, Barrett B, Ebell MH. Antibiotics Not Associated with Shorter Duration or Reduced Severity of Acute Lower Respiratory Tract Infection. J Gen Intern Med 2024; 39:1887-1894. [PMID: 38619737 PMCID: PMC11282002 DOI: 10.1007/s11606-024-08758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Antibiotic use remains common for the treatment of lower respiratory tract infections. The objective of this study was to evaluate the impact of antibiotic use on the duration and severity of acute lower respiratory tract infection (LRTI). PARTICIPANTS Adult patients presenting to US primary or urgent care sites with a chief complaint of cough and symptoms consistent with LRTI. MAIN MEASURES Collected data included demographics, comorbidities, symptoms, and 48 viral and bacterial respiratory pathogens by PCR. Severity of signs/symptoms was reported for up to 28 days using diaries and text messages. Interpolation was used where data were missing. KEY RESULTS Of 718 patients with baseline data, 29% had an antibiotic prescribed at baseline. The most common antibiotics were amoxicillin-clavulanate, azithromycin, doxycycline, and amoxicillin in 85% of patients. Provision of an antibiotic had no effect on the duration or overall severity of cough, including in patients with viral, bacterial, and mixed infections. Receipt of an antibiotic did reduce the likelihood of a follow-up visit (14.1% vs 8.2%, aOR 0.47, 95% CI 0.26-0.84), perhaps by removing the motivation of getting an antibiotic at a follow-up visit. However, they were also more likely to receive a systemic corticosteroid (31.9% vs 4.5%, p < 0.001) and were also more likely to receive an albuterol inhaler (22.7% vs 7.6%, p < 0.001). Patients believed that receiving an antibiotic would reduce the duration of their illness by nearly 4 days. CONCLUSIONS In this large prospective study in the US primary and urgent care setting, antibiotics had no measurable impact on the severity or duration of cough due to acute LRTI. Patients had unrealistic expectations regarding the duration of LRTI and the effect of antibiotics which should be the target of antibiotic stewardship efforts.
Collapse
Affiliation(s)
- Daniel J Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, USA.
- Department of Human Science, School of Health, Georgetown University Medical Center, Washington, DC, USA.
| | - Bruce Barrett
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| |
Collapse
|
3
|
Shaikh N, Conway SJ, Kovačević J, Condessa F, Shope TR, Haralam MA, Campese C, Lee MC, Larsson T, Cavdar Z, Hoberman A. Development and Validation of an Automated Classifier to Diagnose Acute Otitis Media in Children. JAMA Pediatr 2024; 178:401-407. [PMID: 38436941 PMCID: PMC10985552 DOI: 10.1001/jamapediatrics.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 03/05/2024]
Abstract
Importance Acute otitis media (AOM) is a frequently diagnosed illness in children, yet the accuracy of diagnosis has been consistently low. Multiple neural networks have been developed to recognize the presence of AOM with limited clinical application. Objective To develop and internally validate an artificial intelligence decision-support tool to interpret videos of the tympanic membrane and enhance accuracy in the diagnosis of AOM. Design, Setting, and Participants This diagnostic study analyzed otoscopic videos of the tympanic membrane captured using a smartphone during outpatient clinic visits at 2 sites in Pennsylvania between 2018 and 2023. Eligible participants included children who presented for sick visits or wellness visits. Exposure Otoscopic examination. Main Outcomes and Measures Using the otoscopic videos that were annotated by validated otoscopists, a deep residual-recurrent neural network was trained to predict both features of the tympanic membrane and the diagnosis of AOM vs no AOM. The accuracy of this network was compared with a second network trained using a decision tree approach. A noise quality filter was also trained to prompt users that the video segment acquired may not be adequate for diagnostic purposes. Results Using 1151 videos from 635 children (majority younger than 3 years of age), the deep residual-recurrent neural network had almost identical diagnostic accuracy as the decision tree network. The finalized deep residual-recurrent neural network algorithm classified tympanic membrane videos into AOM vs no AOM categories with a sensitivity of 93.8% (95% CI, 92.6%-95.0%) and specificity of 93.5% (95% CI, 92.8%-94.3%) and the decision tree model had a sensitivity of 93.7% (95% CI, 92.4%-94.9%) and specificity of 93.3% (92.5%-94.1%). Of the tympanic membrane features outputted, bulging of the TM most closely aligned with the predicted diagnosis; bulging was present in 230 of 230 cases (100%) in which the diagnosis was predicted to be AOM in the test set. Conclusions and Relevance These findings suggest that given its high accuracy, the algorithm and medical-grade application that facilitates image acquisition and quality filtering could reasonably be used in primary care or acute care settings to aid with automated diagnosis of AOM and decisions regarding treatment.
Collapse
Affiliation(s)
- Nader Shaikh
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pennsylvania
| | - Shannon J. Conway
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pennsylvania
| | - Jelena Kovačević
- Tandon School of Engineering, New York University, New York, New York
| | - Filipe Condessa
- Bosch Center for Artificial Intelligence, Pittsburgh, Pennsylvania
| | - Timothy R. Shope
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pennsylvania
| | - Mary Ann Haralam
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pennsylvania
| | - Catherine Campese
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pennsylvania
| | - Matthew C. Lee
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pennsylvania
| | | | | | - Alejandro Hoberman
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pennsylvania
| |
Collapse
|
4
|
Lee MC, Kavalieratos D, Alberty A, Groff D, Haralam MA, Shaikh N. Parents' experiences caring for children with acute otitis media: a qualitative analysis. BMC PRIMARY CARE 2022; 23:123. [PMID: 35606702 PMCID: PMC9128094 DOI: 10.1186/s12875-022-01737-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/16/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Little is known regarding parents' experiences caring for children with acute otitis media (AOM). This study aimed to explore parents' experiences caring for their child with AOM, identifying symptoms they observed, their thoughts and feelings about those symptoms, how they managed the episode, and what factors caused them to seek medical evaluation. METHODS From October 2019 to February 2020, we conducted 24 semi-structured cross-sectional interviews with parents of children 3 to 36 months of age with AOM diagnosed at primary care offices associated with the Children's Hospital of Pittsburgh regarding (1) symptoms and behaviors that led parents to believe their child might have AOM; (2) symptoms that were most bothersome to parent and child; (3) what parents did in response to these symptoms; (4) motivations for seeking clinical care; and (5) parents' expectations regarding AOM resolution. Data were analyzed using template analysis, resulting in a hybrid inductive/deductive analytic process. RESULTS We interviewed 24 parents within 72 h of diagnosis of AOM. Parents frequently believed ear tugging was the symptom most indicative of AOM, despite its presence in only half of the children in this sample. Parents consistently sought medical care when their child had an elevated temperature or lack of sleep, or when symptoms worsened or were unresponsive to home remedies. Parents of children with history of recurrent AOM had less difficulty identifying symptoms of AOM than parents of children with their first ear infection. CONCLUSIONS Our findings provide insight into symptoms of AOM that cause parents concern and motivate the use of healthcare services. Parents differed in their abilities to observe and report symptoms of AOM. Thus, when interviewing parents who are concerned their preverbal child has AOM, rather than focusing on ear tugging and fever alone, providers should ascertain all unusual behaviors observed by the parent.
Collapse
Affiliation(s)
- Matthew C Lee
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dio Kavalieratos
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anastasia Alberty
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Destin Groff
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Ann Haralam
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nader Shaikh
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
5
|
Lin H, Jia Y, Kong X, Wang S, Liu X, Liu Y, Deng Y. In Vivo Evaluation of Cefuroxime Axetil-Loaded Bioadhesive Nanoparticles to Treat Haemophilus influenzae-Induced Otitis Media. Front Bioeng Biotechnol 2022; 10:884797. [PMID: 35573224 PMCID: PMC9099258 DOI: 10.3389/fbioe.2022.884797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Otitis media (OM) is a common disease in children. One of the most common pathogens causing OM is non-typeable Haemophilus influenzae (NTHi). NTHi in the middle ear can be successfully eradicated by a regimen of oral antibiotics sustained for 7–10 days (e.g., cefuroxime axetil 250 mg/day for patients aged 3 months to 2 years and 500 mg/day for patients ages ≥2 years). However, lack of compliance is relevant to treatment failure or early relapse. In order to overcome these challenges, we have developed antibiotics-loaded bioadhesive nanoparticles (BNPs) that can adhere to the epidermis of the middle ear after local administration and significantly prolong the release time of antibiotics in the middle ear. Compared with oral administration of CA, local delivery of free antibiotic cefuroxime axetil (CA), and CA loaded non-bioadhesive nanoparticles (CA/NNPs), BNPs loaded with cefuroxime axetil (CA/BNPs) showed significantly longer retention time in the middle ear, resulting in continuous release of the drug and higher therapeutic efficacy against OM with only a single dosage. CA concentrations were maintained above the minimum inhibitory concentration (MIC) for NTHi throughout 7 days’ treatment. NTHi OM in a mouse model was successfully eradicated without causing tissue toxicity. CA/BNPs minimize systemic drug exposure through local administration, as demonstrated by undetectable levels in the blood.
Collapse
Affiliation(s)
| | | | | | | | | | - Yang Liu
- *Correspondence: Yang Liu, ; Yang Deng,
| | - Yang Deng
- *Correspondence: Yang Liu, ; Yang Deng,
| |
Collapse
|
6
|
Hay AD, Moore MV, Taylor J, Turner N, Noble S, Cabral C, Horwood J, Prasad V, Curtis K, Delaney B, Damoiseaux R, Domínguez J, Tapuria A, Harris S, Little P, Lovering A, Morris R, Rowley K, Sadoo A, Schilder A, Venekamp R, Wilkes S, Curcin V. Immediate oral versus immediate topical versus delayed oral antibiotics for children with acute otitis media with discharge: the REST three-arm non-inferiority electronic platform-supported RCT. Health Technol Assess 2021; 25:1-76. [PMID: 34816795 DOI: 10.3310/hta25670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Acute otitis media is a painful infection of the middle ear that is commonly seen in children. In some children, the eardrum spontaneously bursts, discharging visible pus (otorrhoea) into the outer ear. OBJECTIVE To compare the clinical effectiveness of immediate topical antibiotics or delayed oral antibiotics with the clinical effectiveness of immediate oral antibiotics in reducing symptom duration in children presenting to primary care with acute otitis media with discharge and the economic impact of the alternative strategies. DESIGN This was a pragmatic, three-arm, individually randomised (stratified by age < 2 vs. ≥ 2 years), non-inferiority, open-label trial, with economic and qualitative evaluations, supported by a health-record-integrated electronic trial platform [TRANSFoRm (Translational Research and Patient Safety in Europe)] with an internal pilot. SETTING A total of 44 English general practices. PARTICIPANTS Children aged ≥ 12 months and < 16 years whose parents (or carers) were seeking medical care for unilateral otorrhoea (ear discharge) following recent-onset (≤ 7 days) acute otitis media. INTERVENTIONS (1) Immediate ciprofloxacin (0.3%) solution, four drops given three times daily for 7 days, or (2) delayed 'dose-by-age' amoxicillin suspension given three times daily (clarithromycin twice daily if the child was penicillin allergic) for 7 days, with structured delaying advice. All parents were given standardised information regarding symptom management (paracetamol/ibuprofen/fluids) and advice to complete the course. COMPARATOR Immediate 'dose-by-age' oral amoxicillin given three times daily (or clarithromycin given twice daily) for 7 days. Parents received standardised symptom management advice along with advice to complete the course. MAIN OUTCOME MEASURE Time from randomisation to the first day on which all symptoms (pain, fever, being unwell, sleep disturbance, otorrhoea and episodes of distress/crying) were rated 'no' or 'very slight' problem (without need for analgesia). METHODS Participants were recruited from routine primary care appointments. The planned sample size was 399 children. Follow-up used parent-completed validated symptom diaries. RESULTS Delays in software deployment and configuration led to small recruitment numbers and trial closure at the end of the internal pilot. Twenty-two children (median age 5 years; 62% boys) were randomised: five, seven and 10 to immediate oral, delayed oral and immediate topical antibiotics, respectively. All children received prescriptions as randomised. Seven (32%) children fully adhered to the treatment as allocated. Symptom duration data were available for 17 (77%) children. The median (interquartile range) number of days until symptom resolution in the immediate oral, delayed oral and immediate topical antibiotic arms was 6 (4-9), 4 (3-7) and 4 (3-6), respectively. Comparative analyses were not conducted because of small numbers. There were no serious adverse events and six reports of new or worsening symptoms. Qualitative clinician interviews showed that the trial question was important. When the platform functioned as intended, it was liked. However, staff reported malfunctioning software for long periods, resulting in missed recruitment opportunities. Troubleshooting the software placed significant burdens on staff. LIMITATIONS The over-riding weakness was the failure to recruit enough children. CONCLUSIONS We were unable to answer the main research question because of a failure to reach the required sample size. Our experience of running an electronic platform-supported trial in primary care has highlighted challenges from which we have drawn recommendations for the National Institute for Health Research (NIHR) and the research community. These should be considered before such a platform is used again. TRIAL REGISTRATION Current Controlled Trials ISRCTN12873692 and EudraCT 2017-003635-10. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 67. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael V Moore
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Jodi Taylor
- Bristol Randomised Trials Collaboration, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Bristol Randomised Trials Collaboration, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Bristol Randomised Trials Collaboration, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christie Cabral
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vibhore Prasad
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kathryn Curtis
- Bristol Randomised Trials Collaboration, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Brendan Delaney
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Roger Damoiseaux
- Julius Center for Health Sciences and Primary Care & Department of Otorhinolaryngology, UMC Utrecht, Utrecht, the Netherlands
| | - Jesús Domínguez
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Archana Tapuria
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sue Harris
- Bristol Randomised Trials Collaboration, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Andrew Lovering
- Department of Medical Microbiology, North Bristol NHS Trust, Bristol, UK
| | - Richard Morris
- Bristol Randomised Trials Collaboration, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Rowley
- Bristol Randomised Trials Collaboration, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annie Sadoo
- Bristol Randomised Trials Collaboration, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anne Schilder
- Ear Institute, University College London, London, UK
| | - Roderick Venekamp
- Julius Center for Health Sciences and Primary Care & Department of Otorhinolaryngology, UMC Utrecht, Utrecht, the Netherlands
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
7
|
Uldbjerg CS, Miller JE, Burgner D, Pedersen LH, Bech BH. Antibiotic exposure during pregnancy and childhood asthma: a national birth cohort study investigating timing of exposure and mode of delivery. Arch Dis Child 2021; 106:888-894. [PMID: 33563603 DOI: 10.1136/archdischild-2020-319659] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate whether antibiotic exposure during pregnancy was associated with childhood asthma and if this relationship was conditional on timing of exposure and mode of delivery. DESIGN A cohort study using multivariable logistic regression models adjusting for a priori defined confounders. Pregnant women were recruited from 1996 to 2002. SETTING The Danish National Birth Cohort. PATIENTS Of the 96 832 children in the cohort, 32 651 children were included in the study population. MAIN OUTCOME MEASURE Parent-reported childhood asthma at 11 years. RESULTS A total of 5522 (17%) children were born to mothers exposed to antibiotics during pregnancy. In adjusted analyses, children born to exposed mothers had higher odds of asthma (OR 1.14, 95% CI 1.05 to 1.24). There was no association with antibiotic exposure in the first trimester (OR 1.02, 95% CI 0.83 to 1.26), but higher odds were observed for antibiotic exposure in the second to third trimester (OR 1.17, 95% CI 1.06 to 1.28), compared with unexposed children. The overall association between antibiotics during pregnancy and childhood asthma was only observed in vaginally born children (OR 1.17, 95% CI 1.07 to 1.28) but not in caesarean section born children (planned caesarean section: OR 0.95, 95% CI 0.66 to 1.37; caesarean emergency: OR 0.96, 95% CI 0.73 to 1.28). In exposed vaginally born children, the odds for childhood asthma requiring treatment during the preceding year were 34% higher (OR 1.34, 95% CI 1.21 to 1.49), compared with unexposed vaginally born children. CONCLUSIONS Antibiotic exposure in mid-to-late pregnancy is associated with higher odds of childhood asthma in vaginally born children. Mode of delivery may modify the association.
Collapse
Affiliation(s)
| | - Jessica E Miller
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Lars Henning Pedersen
- Department of Clinical Medicine and Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| |
Collapse
|
8
|
Merenstein D, Fraser CM, Roberts RF, Liu T, Grant-Beurmann S, Tan TP, Smith KH, Cronin T, Martin OA, Sanders ME, Lucan SC, Kane MA. Bifidobacterium animalis subsp. lactis BB-12 Protects against Antibiotic-Induced Functional and Compositional Changes in Human Fecal Microbiome. Nutrients 2021; 13:nu13082814. [PMID: 34444974 PMCID: PMC8398419 DOI: 10.3390/nu13082814] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 01/04/2023] Open
Abstract
The administration of broad-spectrum antibiotics is often associated with antibiotic-associated diarrhea (AAD), and impacts gastrointestinal tract homeostasis, as evidenced by the following: (a) an overall reduction in both the numbers and diversity of the gut microbiota, and (b) decreased short-chain fatty acid (SCFA) production. Evidence in humans that probiotics may enhance the recovery of microbiota populations after antibiotic treatment is equivocal, and few studies have addressed if probiotics improve the recovery of microbial metabolic function. Our aim was to determine if Bifidobacterium animalis subsp. lactis BB-12 (BB-12)-containing yogurt could protect against antibiotic-induced fecal SCFA and microbiota composition disruptions. We conducted a randomized, allocation-concealed, controlled trial of amoxicillin/clavulanate administration (days 1-7), in conjunction with either BB-12-containing or control yogurt (days 1-14). We measured the fecal levels of SCFAs and bacterial composition at baseline and days 7, 14, 21, and 30. Forty-two participants were randomly assigned to the BB-12 group, and 20 participants to the control group. Antibiotic treatment suppressed the fecal acetate levels in both the control and probiotic groups. Following the cessation of antibiotics, the fecal acetate levels in the probiotic group increased over the remainder of the study and returned to the baseline levels on day 30 (-1.6% baseline), whereas, in the control group, the acetate levels remained suppressed. Further, antibiotic treatment reduced the Shannon diversity of the gut microbiota, for all the study participants at day 7. The magnitude of this change was larger and more sustained in the control group compared to the probiotic group, which is consistent with the hypothesis that BB-12 enhanced microbiota recovery. There were no significant baseline clinical differences between the two groups. Concurrent administration of amoxicillin/clavulanate and BB-12 yogurt, to healthy subjects, was associated with a significantly smaller decrease in the fecal SCFA levels and a more stable taxonomic profile of the microbiota over time than the control group.
Collapse
Affiliation(s)
- Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC 20057, USA; (T.P.T.); (K.H.S.); (T.C.)
- Department of Human Science, School of Nursing and Health Studies, Georgetown University Medical Center, Washington, DC 20057, USA
- Correspondence: (D.M.); (C.M.F.); (M.A.K.); Tel.: +1-202-687-2745 (D.M.); +1-410-706-3879 (C.M.F.); +1-410-706-5097 (M.A.K.)
| | - Claire M. Fraser
- Institute for Genomic Sciences, Departments of Medicine and Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (S.G.-B.); (O.A.M.)
- Correspondence: (D.M.); (C.M.F.); (M.A.K.); Tel.: +1-202-687-2745 (D.M.); +1-410-706-3879 (C.M.F.); +1-410-706-5097 (M.A.K.)
| | - Robert F. Roberts
- Department of Food Science, The Pennsylvania State University, University Park, PA 16802, USA;
| | - Tian Liu
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA;
| | - Silvia Grant-Beurmann
- Institute for Genomic Sciences, Departments of Medicine and Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (S.G.-B.); (O.A.M.)
| | - Tina P. Tan
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC 20057, USA; (T.P.T.); (K.H.S.); (T.C.)
| | - Keisha Herbin Smith
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC 20057, USA; (T.P.T.); (K.H.S.); (T.C.)
| | - Tom Cronin
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC 20057, USA; (T.P.T.); (K.H.S.); (T.C.)
| | - Olivia A. Martin
- Institute for Genomic Sciences, Departments of Medicine and Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (S.G.-B.); (O.A.M.)
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | | | - Sean C. Lucan
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY 10461, USA;
| | - Maureen A. Kane
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA;
- Correspondence: (D.M.); (C.M.F.); (M.A.K.); Tel.: +1-202-687-2745 (D.M.); +1-410-706-3879 (C.M.F.); +1-410-706-5097 (M.A.K.)
| |
Collapse
|
9
|
Meherali S, Hartling L, Campbell A, Robin F, Scott S. Parent information needs and experience regarding acute otitis media in children: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:554-562. [PMID: 32998839 DOI: 10.1016/j.pec.2020.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/07/2020] [Accepted: 09/12/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Acute otitis media (AOM)-inflammation of the middle ear-is the most common pediatric condition, affecting up to 75 % of children at some time before age 5 years. Despite the high incidence of AOM in children, it presents diverse challenges to parents who do not have accurate information on AOM and its management. OBJECTIVE To respond to this paucity of information we sought to synthesize the literature to provide a comprehensive understanding of parental information needs and experiences relating to AOMmanagement. This systematic review is an important first step in developing parent-informed knowledge translation tools for AOM to bridge the knowledge-practice gap. PATIENT INVOLVEMENT None. METHOD Four electronic databases were searched and articles were screened according to pre- established inclusion criteria. Articles were included in the review if they (1) examined parental information needs and experiences with respect to AOM; (2) were written in English; and (3) were published from January 2000 onward. RESULTS Out of 1121 articles retrieved, 21 articles met the inclusion criteria. The findings from this review revealed that parents' knowledge about AOM is generally limited. Further, parents were often poorly informed about what AOM was, which resulted in uncertainty about how to help their child with AOM. DISCUSSION Our review findings illustrate that parents of children with AOM have pervasive unmet information needs and information deficits negatively impact AOM management, child and family well-being. PRACTICAL VALUE Parental experiences and information needs identified through this review were used to develop innovative, evidence-based knowledge translation tools for parents of children with AOM.
Collapse
|
10
|
Curtis K, Moore M, Cabral C, Curcin V, Horwood J, Morris R, Prasad V, Schilder A, Turner N, Wilkes S, Hay AD, Taylor J. A multi-centre, pragmatic, three-arm, individually randomised, non-inferiority, open trial to compare immediate orally administered, immediate topically administered or delayed orally administered antibiotics for acute otitis media with discharge in children: The Runny Ear Study (REST): study protocol. Trials 2020; 21:463. [PMID: 32493407 PMCID: PMC7268414 DOI: 10.1186/s13063-020-04419-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute otitis media (AOM) is a common painful infection in children, with around 2.8 million cases presenting to primary care in England and Wales annually. Nearly all children who present to their general practitioner (GP) with AOM or AOM with discharge (AOMd) are treated with orally administered antibiotics. These can cause side effects; contribute to the growing problem of antimicrobial resistance, and more rarely, allergic reactions. Alternative treatments, such as an antibiotic eardrops, or 'delayed' orally administered antibiotics, could be at least as effective and safe as immediate orally administered antibiotics for children with AOMd. METHODS/DESIGN REST is a pragmatic, three-arm, individually randomised, non-inferiority trial being conducted in 175 GP practices across the United Kingdom (UK). The study aims to recruit 399 children aged (≥ 12 months and < 16 years) presenting to their GP with AOMd. Children will be randomised to one of three arms: immediate ciprofloxacin 0.3% eardrops; delayed orally administered amoxicillin (clarithromycin if penicillin allergic) or immediate orally administered amoxicillin (clarithromycin). Recruitment, including eligibility screening, randomisation and data collection, are conducted using the innovative, TRANSFoRm electronic trial management platform. Integrated within the primary care electronic medical records it provides automatic eligibility checking, part-filling of e-CRFs, study workflow management and routine NHS follow-up data collection. The primary outcome is time to resolution of all significant symptoms and will be collected by the parent using a Symptom Recovery Questionnaire (SRQ). Secondary outcomes, including cost-effectiveness, duration of moderately bad or worse symptoms and repeat AOMd episodes, will be collected at day-14 and at 3 months. DISCUSSION It is unclear whether prescribing orally administered antibiotics to children with AOMd results in a reduction in symptoms or a shorter duration of illness. The REST trial should allow us to compare the non-inferiority of: immediate topically administered ciprofloxacin ear drops, or delayed orally administered amoxicillin (clarithromycin) against immediate orally administered amoxicillin (clarithromycin). We aim to recruit 399 patients from 175 practices in the UK. Using the TRANSFoRm software to randomise participants to the trial will enable recruitment for a relatively uncommon condition. TRIAL REGISTRATION Name of Registry: ISCRTN Registration Number: ISRCTN12873692. This contains all items required to comply with the World Health Organization Trial Registration Data Set Date of Registration: 24 April 2018 Name of Registry: EudraCT Registration Number: 2017-003635-10 Date of Registration: 6 September 2017.
Collapse
Affiliation(s)
- Kathryn Curtis
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS82PS, UK
| | - Michael Moore
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University Of Southampton, Southampton, SO17 1BJ, UK
| | - Christie Cabral
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS82PS, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House 3.07, Guy's Campus, London, SE1 1UL, UK
| | - Jeremey Horwood
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS82PS, UK
| | - Richard Morris
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS82PS, UK
| | - Vibhore Prasad
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House 3.07, Guy's Campus, London, SE1 1UL, UK
| | - Anne Schilder
- evidENT, UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, 330 Grays Inn Road, London, WC1X 8DA, UK
| | - Nicholas Turner
- Bristol Randomised Trial Collaboration (BRTC), part of the Bristol Trial Centre, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS82PS, UK
| | - Scott Wilkes
- School of Medicine, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sciences Complex, City Campus, Chester Road, Sunderland, SR1 3SD, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS82PS, UK
| | - Jodi Taylor
- Bristol Randomised Trial Collaboration (BRTC), part of the Bristol Trial Centre, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS82PS, UK.
| |
Collapse
|
11
|
Hong W, Khampang P, Kerschner AR, Mackinnon AC, Yan K, Simpson PM, Kerschner JE. Antibiotic modulation of mucins in otitis media; should this change our approach to watchful waiting? Int J Pediatr Otorhinolaryngol 2019; 125:134-140. [PMID: 31302575 PMCID: PMC6742428 DOI: 10.1016/j.ijporl.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/05/2019] [Accepted: 07/02/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Gel-forming mucins (GFMs) play important roles in otitis media (OM) pathogenesis. Increased mucin expression is activated by pathogens and proinflammatory cytokines. Bacterial biofilms influence inflammation and resolution of OM and may contribute to prolonged mucin production. The influence of specific pathogens on mucin expression and development of chronic OM with effusion (OME) remains an area of significant knowledge deficit. OBJECTIVES To assess the relationship between GFM expression, specific pathogens, middle ear mucosal (MEM) changes, biofilm formation, and antibiotic utilization. METHODS Mixed gender chinchillas were inoculated with nontypeable Haemophilus influenzae (NTHi) strain 86028NP or Streptococcus pneumoniae (SP) strain TIGR4 via transbulla injection. Antibiotic was administered on day 3-5 post inoculation. GFM expression was measured by quantitative PCR. Biofilm formation was identified and middle ear histologic changes were measured. RESULTS SP infection resulted in higher incidence of biofilm and ME effusion compared with NTHi infection. However, NTHi persisted in the ME longer than SP with no substantive bacterial clearance detected on day 10 compared with complete bacterial clearance on day 10 for 50-60% of the SP-infected chinchillas. Both infections increased MEM inflammatory cell infiltration and thickening. NTHi upregulated the Muc5AC, Muc5B and Muc19 expression on day 10 (p = 0.0004, 0.003, and 0.002 respectively). SP-induced GFM upregulations were trended toward significant. In both NTHi and SP infections, the degree of GFM upregulation had a direct relationship to increased MEM hypertrophy, inflammatory cell infiltration and biofilm formation. Antibiotic treatment reduced the incidence of ME effusion and biofilm, limited the MEM changes and reversed the GFM upregulation. In NTHi infection, the rate of returning to baseline level of GFMs in treated chinchillas was quicker than those without treatment. CONCLUSIONS In an animal model of OM, GFM genes are upregulated in conjunction with MEM hypertrophy and biofilm formation. This upregulation is less robust and more quickly ameliorated to a significant degree in the NTHi infection with appropriate antibiotic therapy. These findings contribute to the understanding of pathogen specific influences on mucin expression during OM pathogenesis and provide new data which may have implications in clinical approach for OM treatment.
Collapse
Affiliation(s)
- Wenzhou Hong
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA
| | - Pawjai Khampang
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA
| | - Abigail R Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA
| | | | - Ke Yan
- Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, USA
| | - Pippa M Simpson
- Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, USA
| | - Joseph E Kerschner
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, USA; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA.
| |
Collapse
|
12
|
Cabral C, Horwood J, Symonds J, Ingram J, Lucas PJ, Redmond NM, Kai J, Hay AD, Barnes RK. Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach. BMC FAMILY PRACTICE 2019; 20:102. [PMID: 31324157 PMCID: PMC6642577 DOI: 10.1186/s12875-019-0993-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/09/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing. Clinicians' prescribing decisions are influenced by perceived parental expectations for antibiotics, however there is evidence that parents actually prefer to avoid antibiotics. This study aimed to investigate the influence of parent-clinician communication on antibiotic prescribing for RTI in children in England. METHODS A mixed methods analysis of videoed primary care consultations for children (under 12 years) with acute cough and RTI. Consultations were video-recorded in six general practices in southern England, selected for socio-economic diversity. 56 recordings were transcribed in detail and a subset of recordings and transcripts used to develop a comprehensive interaction-based coding scheme. The scheme was used to examine communication practices between parents and clinicians and how these related to antibiotic or non-antibiotic treatment strategies. RESULTS Parents' communication rarely implied an expectation for antibiotics, some explicitly offering a possible viral diagnosis. Clinicians mostly gave, or implied, a viral diagnosis and mainly recommended non-antibiotic treatment strategies. In the minority of cases where parents' communication behaviours implied they may be seeking antibiotic treatment, antibiotics were not usually prescribed. Where clinicians did prescribe antibiotics, they voiced concern about symptoms or signs, including chest pain, discoloured phlegm, prolonged fever, abnormal chest sounds, or pink /bulging ear drums. CONCLUSIONS We found little evidence of a relationship between parents' communication behaviours and antibiotic prescribing. Rather, where antibiotics were prescribed, this was associated with clinicians' expressed concerns regarding symptoms and signs.
Collapse
Affiliation(s)
- Christie Cabral
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jeremy Horwood
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jon Symonds
- Children and Families Research Centre, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Jenny Ingram
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Patricia J. Lucas
- Centre for Health & Social Care, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Niamh M. Redmond
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Joe Kai
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - Alastair D. Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Rebecca K. Barnes
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW To examine the relationship between vitamin D and otitis media. RECENT FINDINGS Vitamin D deficiency has been associated with several respiratory diseases, including otitis media. Vitamin D supplementation may reduce the risk of otitis media. This relationship may be explained by vitamin D supporting the immune system by upregulating antimicrobial peptides which are effective against otopathogens and biofilm formation, supporting a less inflammatory immune response, or promoting beneficial commensal bacteria. This review will explore risk factors of both otitis media and vitamin D deficiency, the evidence of vitamin D being beneficial for various forms of otitis media, and possible mechanisms of action.
Collapse
|
14
|
Westphal DW, Lehmann D, Williams SA, Richmond PC, Lannigan FJ, Fathima P, Blyth CC, Moore HC. Australian Aboriginal children have higher hospitalization rates for otitis media but lower surgical procedures than non-Aboriginal children: A record linkage population-based cohort study. PLoS One 2019; 14:e0215483. [PMID: 31013285 PMCID: PMC6478284 DOI: 10.1371/journal.pone.0215483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/02/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Otitis media (OM) is one of the most common infectious diseases affecting children globally and the most common reason for antibiotic prescription and paediatric surgery. Australian Aboriginal children have higher rates of OM than non-Aboriginal children; however, there are no data comparing OM hospitalization rates between them at the population level. We report temporal trends for OM hospitalizations and in-hospital tympanostomy tube insertion (TTI) in a cohort of 469,589 Western Australian children born between 1996 and 2012. Materials and methods We used the International Classification of Diseases codes version 10 to identify hospitalizations for OM or TTI recorded as a surgical procedure. Using age-specific population denominators, we calculated hospitalization rates per 1,000 child-years by age, year and level of socio-economic deprivation. Results There were 534,674 hospitalizations among 221,588 children hospitalized at least once before age 15 years. Aboriginal children had higher hospitalization rates for OM than non-Aboriginal children (23.3/1,000 [95% Confidence Interval (CI) 22.8,24.0] vs 2.4/1,000 [95% CI 2.3,2.4] child-years) with no change in disparity over time. Conversely non-Aboriginal children had higher rates of TTI than Aboriginal children (13.5 [95% CI 13.2,13.8] vs 10.1 [95% CI 8.9,11.4]). Children from lower socio-economic backgrounds had higher OM hospitalization rates than those from higher socio-economic backgrounds, although for Aboriginal children hospitalization rates were not statistically different across all levels of socio-economic disadvantage. Hospitalizations for TTI among non-Aboriginal children were more common among those from higher socio-economic backgrounds. This was also true for Aboriginal children; however, the difference was not statistically significant. There was a decline in OM hospitalization rates between 1998 and 2005 and remained stable thereafter. Conclusion Aboriginal children and children from lower socio-economic backgrounds were over-represented with OM-related hospitalizations but had fewer TTIs. Despite a decrease in OM and TTI hospitalization rates during the first half of the study for all groups, the disparity between Aboriginal and non-Aboriginal children and between those of differing socioeconomic deprivation remained.
Collapse
Affiliation(s)
- Darren W. Westphal
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- * E-mail:
| | - Deborah Lehmann
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Stephanie A. Williams
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Peter C. Richmond
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Francis J. Lannigan
- Division of Surgery, Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
- Sidra Medicine, Doha, Qatar
| | - Parveen Fathima
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher C. Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
| | - Hannah C. Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
15
|
Yang R, Sabharwal V, Shlykova N, Okonkwo OS, Pelton SI, Kohane DS. Treatment of Streptococcus pneumoniae otitis media in a chinchilla model by transtympanic delivery of antibiotics. JCI Insight 2018; 3:123415. [PMID: 30282835 DOI: 10.1172/jci.insight.123415] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
Otits media (OM) is the most frequent indication for antimicrobial prescription to US children. Streptococcus pneumoniae (S. pneumoniae) remains one of the most common pathogens causing OM. Successful eradication of S. pneumoniae in the middle ear can be achieved by adhering to a 7-10 day regimen of oral antibiotics. However, oral drug administration is challenging for parents. Lack of adherence has been associated with treatment failure or early relapse. To overcome this challenge, we used a noninvasive formulation to achieve high transtympanic antibiotic flux and cured S. pneumoniae OM in chinchillas. The formulation consists of a thermosensitive in situ gelling hydrogel, chemical permeation enhancers, and an antibiotic. The direct transport of drugs into the middle ear produced high concentrations of ciprofloxacin (in the range of hundreds of micrograms per milliliter) within the first 24 hours of administration. Drug concentrations above the minimum inhibitory concentration (MIC) for S. pneumoniae were sustained throughout the 7-day treatment. S. pneumoniae OM in a chinchilla model was successfully eradicated, without causing tissue toxicity. Transtympanic delivery minimized systemic drug exposure, as evidenced by undetectable levels in blood, measured by high-performance liquid chromatography.
Collapse
Affiliation(s)
- Rong Yang
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston Massachusetts, USA
| | - Vishakha Sabharwal
- Division of Pediatric Infectious Diseases, Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Nadya Shlykova
- Division of Pediatric Infectious Diseases, Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Obiajulu S Okonkwo
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston Massachusetts, USA
| | - Stephen I Pelton
- Division of Pediatric Infectious Diseases, Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Daniel S Kohane
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston Massachusetts, USA
| |
Collapse
|
16
|
Paul CR, Keeley MG, Rebella GS, Frohna JG. Teaching Pediatric Otoscopy Skills to Pediatric and Emergency Medicine Residents: A Cross-Institutional Study. Acad Pediatr 2018; 18:692-697. [PMID: 29499380 DOI: 10.1016/j.acap.2018.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 02/03/2018] [Accepted: 02/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate a pediatric otoscopy curriculum with the use of outcome measures that included assessment of skills with real patients. METHODS Thirty-three residents in an intervention group from 2 institutions received the curriculum. In the previous year, 21 residents in a nonintervention group did not receive the curriculum. Both groups were evaluated at the beginning and end of their internship years with the use of the same outcome assessments: 1) a written test, 2) an objective standardized clinical examination (OSCE), and 3) direct observation of skills in real patients with the use of a checklist with established validity. RESULTS The intervention group had a significant increase in percentage reaching minimum passing levels between the beginning and end of the internship year for the written test (12% vs 97%; P < .001), OSCE (0% vs 78%; P < .001), and direct observation (0% vs 75%; P < .001); significant mean percentage gains for the written test (21%; P < .001), OSCE (28%; P < .001), and direct observation (52%; P = .008); and significantly higher (P < .001) mean percentage gains than the nonintervention group on the written test, OSCE, and direct observation. The nonintervention group did not have a significant increase (P = .99) in percentage reaching minimum passing levels, no significant mean percentage gains in the written test (2.7%; P = .30) and direct observation (6.7%; P = .61), and significant regression in OSCE (-5.2%; P = .03). CONCLUSIONS A pediatric otoscopy curriculum with multimodal outcome assessments was successfully implemented across different specialties at multiple institutions and found to yield gains, including in skills with real patients.
Collapse
Affiliation(s)
- Caroline R Paul
- University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Meg G Keeley
- University of Virginia School of Medicine, Charlottesville, Va
| | - Gregory S Rebella
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - John G Frohna
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| |
Collapse
|
17
|
Venekamp RP, Mick P, Schilder AGM, Nunez DA. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev 2018; 5:CD012017. [PMID: 29741289 PMCID: PMC6494623 DOI: 10.1002/14651858.cd012017.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is one of the most common childhood illnesses. While many children experience sporadic AOM episodes, an important group suffer from recurrent AOM (rAOM), defined as three or more episodes in six months, or four or more in one year. In this subset of children AOM poses a true burden through frequent episodes of ear pain, general illness, sleepless nights and time lost from nursery or school. Grommets, also called ventilation or tympanostomy tubes, can be offered for rAOM. OBJECTIVES To assess the benefits and harms of bilateral grommet insertion with or without concurrent adenoidectomy in children with rAOM. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; CENTRAL; MEDLINE; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 4 December 2017. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing bilateral grommet insertion with or without concurrent adenoidectomy and no ear surgery in children up to age 16 years with rAOM. We planned to apply two main scenarios: grommets as a single surgical intervention and grommets as concurrent treatment with adenoidectomy (i.e. children in both the intervention and comparator groups underwent adenoidectomy). The comparators included active monitoring, antibiotic prophylaxis and placebo medication. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Primary outcomes were: proportion of children who have no AOM recurrences at three to six months follow-up (intermediate-term) and persistent tympanic membrane perforation (significant adverse event). Secondary outcomes were: proportion of children who have no AOM recurrences at six to 12 months follow-up (long-term); total number of AOM recurrences, disease-specific and generic health-related quality of life, presence of middle ear effusion and other adverse events at short-term, intermediate-term and long-term follow-up. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS Five RCTs (805 children) with unclear or high risk of bias were included. All studies were conducted prior to the introduction of pneumococcal vaccination in the countries' national immunisation programmes. In none of the trials was adenoidectomy performed concurrently in both groups.Grommets versus active monitoringGrommets were more effective than active monitoring in terms of:- proportion of children who had no AOM recurrence at six months (one study, 95 children, 46% versus 5%; risk ratio (RR) 9.49, 95% confidence interval (CI) 2.38 to 37.80, number needed to treat to benefit (NNTB) 3; low-quality evidence);- proportion of children who had no AOM recurrence at 12 months (one study, 200 children, 48% versus 34%; RR 1.41, 95% CI 1.00 to 1.99, NNTB 8; low-quality evidence);- number of AOM recurrences at six months (one study, 95 children, mean number of AOM recurrences per child: 0.67 versus 2.17, mean difference (MD) -1.50, 95% CI -1.99 to -1.01; low-quality evidence);- number of AOM recurrences at 12 months (one study, 200 children, one-year AOM incidence rate: 1.15 versus 1.70, incidence rate difference -0.55, 95% -0.17 to -0.93; low-quality evidence).Children receiving grommets did not have better disease-specific health-related quality of life (Otitis Media-6 questionnaire) at four (one study, 85 children) or 12 months (one study, 81 children) than those managed by active monitoring (low-quality evidence).One study reported no persistent tympanic membrane perforations among 54 children receiving grommets (low-quality evidence).Grommets versus antibiotic prophylaxisIt is uncertain whether or not grommets are more effective than antibiotic prophylaxis in terms of:- proportion of children who had no AOM recurrence at six months (two studies, 96 children, 60% versus 35%; RR 1.68, 95% CI 1.07 to 2.65, I2 = 0%, fixed-effect model, NNTB 5; very low-quality evidence);- number of AOM recurrences at six months (one study, 43 children, mean number of AOM recurrences per child: 0.86 versus 1.38, MD -0.52, 95% CI -1.37 to 0.33; very low-quality evidence).Grommets versus placebo medicationGrommets were more effective than placebo medication in terms of:- proportion of children who had no AOM recurrence at six months (one study, 42 children, 55% versus 15%; RR 3.64, 95% CI 1.20 to 11.04, NNTB 3; very low-quality evidence);- number of AOM recurrences at six months (one study, 42 children, mean number of AOM recurrences per child: 0.86 versus 2.0, MD -1.14, 95% CI -2.06 to -0.22; very low-quality evidence).One study reported persistent tympanic membrane perforations in 3 of 76 children (4%) receiving grommets (low-quality evidence).Subgroup analysisThere were insufficient data to determine whether presence of middle ear effusion at randomisation, type of grommet or age modified the effectiveness of grommets. AUTHORS' CONCLUSIONS Current evidence on the effectiveness of grommets in children with rAOM is limited to five RCTs with unclear or high risk of bias, which were conducted prior to the introduction of pneumococcal vaccination. Low to very low-quality evidence suggests that children receiving grommets are less likely to have AOM recurrences compared to those managed by active monitoring and placebo medication, but the magnitude of the effect is modest with around one fewer episode at six months and a less noticeable effect by 12 months. The low to very low quality of the evidence means that these numbers need to be interpreted with caution since the true effects may be substantially different. It is uncertain whether or not grommets are more effective than antibiotic prophylaxis. The risk of persistent tympanic membrane perforation after grommet insertion was low.Widespread use of pneumococcal vaccination has changed the bacteriology and epidemiology of AOM, and how this might impact the results of prior trials is unknown. New and high-quality RCTs of grommet insertion in children with rAOM are therefore needed. These trials should not only focus on the frequency of AOM recurrences, but also collect data on the severity of AOM episodes, antibiotic consumption and adverse effects of both surgery and antibiotics. This is particularly important since grommets may reduce the severity of AOM recurrences and allow for topical rather than oral antibiotic treatment.
Collapse
Affiliation(s)
- Roderick P Venekamp
- University Medical Center Utrecht, Utrecht UniversityJulius Center for Health Sciences and Primary Care & Department of OtorhinolaryngologyHeidelberglaan 100UtrechtNetherlands3508 GA
| | - Paul Mick
- University of British ColumbiaDivision of Otolaryngology Head & Neck SurgeryVancouverBCCanada
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College LondonevidENT, Ear Institute330 Grays Inn RoadLondonUKWC1X 8DA
| | - Desmond A Nunez
- University of British ColumbiaDivision of Otolaryngology Head & Neck SurgeryVancouverBCCanada
| | | |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Roston TM, Tran DT, Sanatani S, Sandhu R, Sheldon R, Kaul P. A Population-Based Study of Syncope in the Young. Can J Cardiol 2018; 34:195-201. [PMID: 29407009 DOI: 10.1016/j.cjca.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/02/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The prevalence, hospitalization patterns, and outcomes of pediatric and adolescent syncope have not been rigorously characterized. METHODS Patients < 20 years presenting to an emergency department (ED) with a primary diagnosis of syncope (International Classification of Diseases, 10th revision, code R55) between fiscal year (FY) 2006/2007 and FY 2013/2014 in the province of Alberta, Canada were grouped according to discharge status from the ED, ie, (1) admitted to hospital and (2) discharged without admission. Temporal trends and differences in baseline characteristics, medication use, and outcomes between admitted and discharged patients were examined. RESULTS The prevalence of syncope increased from 143/100,000 population in FY 2006/2007 to 166/100,000 population in FY 2013/2014 (P < 0.01). The majority of the 11,488 patients who presented to the ED with syncope were discharged home (n = 11,214 [98%]). Cardiac disease was present in 12.7% and thoracic conditions were present in 8% of the study population. A majority of patients (66.2% admitted and 56.4% discharged; P = 0.018) were taking a prescription drug in the year before presentation. By 30 days, 26.1% of admitted patients had a second ED presentation and 8.1% had a rehospitalization. Among discharged patients, the 30-day repeated ED presentation rate was 11.7% and the hospitalization rate was 1.1%. By 1 year, the rates of repeated ED visits increased to 64.1% and 47.5%, and rehospitalization rates increased to 21.4% and 6.8% among admitted and discharged patients, respectively. CONCLUSIONS Our data suggest that pediatric and adolescent syncope is increasing in prevalence and represents a growing public health problem. This population has a high burden of comorbidities that likely contribute to increased health care resource use and polypharmacy.
Collapse
Affiliation(s)
- Thomas M Roston
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dat T Tran
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Shubhayan Sanatani
- BC Children's Hospital and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roopinder Sandhu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Sheldon
- Libin Cardiovascular Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Padma Kaul
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
20
|
Reduced-Concentration Clavulanate for Young Children with Acute Otitis Media. Antimicrob Agents Chemother 2017; 61:AAC.00238-17. [PMID: 28438923 DOI: 10.1128/aac.00238-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/08/2017] [Indexed: 11/20/2022] Open
Abstract
Amoxicillin-clavulanate (A/C) is currently the most effective oral antimicrobial in treating children with acute otitis media (AOM), but the standard dosage of 90 mg amoxicillin/6.4 mg clavulanate/kg of body weight/day commonly causes diarrhea. We examined whether an A/C formulation containing lower concentrations of clavulanate would result in less diarrhea while maintaining plasma levels of amoxicillin and clavulanate adequate to eradicate middle-ear pathogens and to achieve clinical success. We conducted an open-label study in children with AOM who were 6 to 23 months of age. In phase 1, we treated 40 children with a reduced-clavulanate A/C formulation providing 90 mg amoxicillin/3.2 mg clavulanate/kg/day for 10 days. In phase 2, we treated 72 children with the same formulation at a dosage of 80 mg amoxicillin/2.85 mg clavulanate/kg/day for 10 days. We compared the rates of protocol-defined diarrhea (PDD), diaper dermatitis, and AOM clinical response in these children with rates we had reported in children who received the standard A/C regimen, and we obtained plasma levels of amoxicillin and clavulanate at various time points. Outcomes in phase 1 children and in children who had received the standard regimen did not differ significantly. Rates of PDD in children receiving phase 2 and standard regimens were 17% and 26%, respectively (P = 0.10). The corresponding rates of diaper dermatitis were 21% and 33% (P = 0.04) and of AOM treatment failure were 12% and 16% (P = 0.44). Symptomatic responses did not differ significantly between regimens; both gave clavulanate levels sufficient to inhibit β-lactamase activity. In young children with AOM, clavulanate dosages lower than those currently used may be associated with fewer side effects without reducing clinical efficacy. (This study has been registered at ClinicalTrials.gov under registration no. NCT02630992.).
Collapse
|
21
|
Hoberman A, Paradise JL, Rockette HE, Kearney DH, Bhatnagar S, Shope TR, Martin JM, Kurs-Lasky M, Copelli SJ, Colborn DK, Block SL, Labella JJ, Lynch TG, Cohen NL, Haralam M, Pope MA, Nagg JP, Green MD, Shaikh N. Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children. N Engl J Med 2016; 375:2446-2456. [PMID: 28002709 PMCID: PMC5319589 DOI: 10.1056/nejmoa1606043] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Limiting the duration of antimicrobial treatment constitutes a potential strategy to reduce the risk of antimicrobial resistance among children with acute otitis media. METHODS We assigned 520 children, 6 to 23 months of age, with acute otitis media to receive amoxicillin-clavulanate either for a standard duration of 10 days or for a reduced duration of 5 days followed by placebo for 5 days. We measured rates of clinical response (in a systematic fashion, on the basis of signs and symptomatic response), recurrence, and nasopharyngeal colonization, and we analyzed episode outcomes using a noninferiority approach. Symptom scores ranged from 0 to 14, with higher numbers indicating more severe symptoms. RESULTS Children who were treated with amoxicillin-clavulanate for 5 days were more likely than those who were treated for 10 days to have clinical failure (77 of 229 children [34%] vs. 39 of 238 [16%]; difference, 17 percentage points [based on unrounded data]; 95% confidence interval, 9 to 25). The mean symptom scores over the period from day 6 to day 14 were 1.61 in the 5-day group and 1.34 in the 10-day group (P=0.07); the mean scores at the day-12-to-14 assessment were 1.89 versus 1.20 (P=0.001). The percentage of children whose symptom scores decreased more than 50% (indicating less severe symptoms) from baseline to the end of treatment was lower in the 5-day group than in the 10-day group (181 of 227 children [80%] vs. 211 of 233 [91%], P=0.003). We found no significant between-group differences in rates of recurrence, adverse events, or nasopharyngeal colonization with penicillin-nonsusceptible pathogens. Clinical-failure rates were greater among children who had been exposed to three or more children for 10 or more hours per week than among those with less exposure (P=0.02) and were also greater among children with infection in both ears than among those with infection in one ear (P<0.001). CONCLUSIONS Among children 6 to 23 months of age with acute otitis media, reduced-duration antimicrobial treatment resulted in less favorable outcomes than standard-duration treatment; in addition, neither the rate of adverse events nor the rate of emergence of antimicrobial resistance was lower with the shorter regimen. (Funded by the National Institute of Allergy and Infectious Diseases and the National Center for Research Resources; ClinicalTrials.gov number, NCT01511107 .).
Collapse
Affiliation(s)
- Alejandro Hoberman
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Jack L Paradise
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Howard E Rockette
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Diana H Kearney
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Sonika Bhatnagar
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Timothy R Shope
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Judith M Martin
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Marcia Kurs-Lasky
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Susan J Copelli
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - D Kathleen Colborn
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Stan L Block
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - John J Labella
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Thomas G Lynch
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Norman L Cohen
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - MaryAnn Haralam
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Marcia A Pope
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Jennifer P Nagg
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Michael D Green
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| | - Nader Shaikh
- From the Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) (A.H., J.L.P., D.H.K., S.B., T.R.S., J.M.M., M.K.-L., S.J.C., D.K.C., M.H., M.A.P., J.P.N., M.D.G., N.S.), the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (H.E.R.), and Children's Community Pediatrics (J.J.L., T.G.L., N.L.C.) - all in Pittsburgh; and Kentucky Pediatric and Adult Research, Bardstown (S.L.B.)
| |
Collapse
|
22
|
Duncan I, Clark K, Wang S. Cost and Utilization of Retail Clinics vs. Other Providers for Treatment of Pediatric Acute Otitis Media. Popul Health Manag 2016; 19:341-8. [DOI: 10.1089/pop.2015.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ian Duncan
- Department of Statistics and Applied Probability, University of California Santa Barbara, Santa Barbara, California
| | | | | |
Collapse
|
23
|
Mbakwa CA, Scheres L, Penders J, Mommers M, Thijs C, Arts ICW. Early Life Antibiotic Exposure and Weight Development in Children. J Pediatr 2016; 176:105-113.e2. [PMID: 27402330 DOI: 10.1016/j.jpeds.2016.06.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/31/2016] [Accepted: 06/03/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the timing, frequency, and type of antibiotic exposure during the first 10 years of life in association with (over)weight across this period in a cohort of 979 children. STUDY DESIGN Within the Child, Parents and Health: Lifestyle and Genetic Constitution Birth Cohort Study, antibiotic exposure record was obtained from general practitioners. Anthropometric outcomes (age- and sex-standardized body mass index, weight and height z-scores, and overweight) were measured repeatedly at 7 time points during the first 10 years of life. Generalized estimating equations method was used for statistical analysis. RESULTS After adjusting for confounding factors, children exposed to one course of antibiotics compared with none in the first 6 months of life had increased weight- (adjusted generalized estimating equations estimates [adjβ] 0.24; 95% CI 0.03-0.44) and height (adjβ 0.23; 95% CI 0.0002-0.46) z-scores; exposure to ≥2 courses during the second year of life was associated with both increased weight (adjβ 0.34; 95% CI 0.07-0.60), and height z-scores (adjβ 0.29; 95% CI -0.003 to 0.59). Exposure later in life was not associated with anthropometric outcomes. Associations with weight z-scores were mainly driven by exposure to broad- (≥2 courses: adjβ 0.11; 95% CI 0.003-0.22) and narrow-spectrum β-lactams (1 course: adjβ 0.18; 95% CI 0.005-0.35) during the follow-up period. Specific antibiotic used was not associated with body mass index z-scores and overweight. CONCLUSIONS Repeated exposure to antibiotics early in life, especially β-lactam agents, is associated with increased weight and height. If causality of obesity can be established in future studies, this further highlights the need for restrictive antibiotic use and avoidance of prescriptions when there is minimal clinical benefit.
Collapse
Affiliation(s)
- Catherine A Mbakwa
- Top Institute Food and Nutrition, Wageningen, The Netherlands; Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
| | - Lotte Scheres
- Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - John Penders
- Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Department of Medical Microbiology, Maastricht University Medical Center, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht and CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Monique Mommers
- Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Carel Thijs
- Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Ilja C W Arts
- Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, and Maastricht Center for Systems Biology (MaCSBio), Maastricht, The Netherlands
| |
Collapse
|
24
|
Jensen JN, Bjerrum L, Boel J, Jarløv JO, Arpi M. Parents' socioeconomic factors related to high antibiotic prescribing in primary health care among children aged 0-6 years in the Capital Region of Denmark. Scand J Prim Health Care 2016; 34:274-81. [PMID: 27408984 PMCID: PMC5036017 DOI: 10.1080/02813432.2016.1207145] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the distribution of antibiotic prescriptions in primary health care among children aged 0-6 years and its association with socioeconomic factors. DESIGN A cross-sectional study describing antibiotic prescriptions and socioeconomic factors, using different population-based registers from Statistics Denmark. SETTING Antibiotic prescriptions in 2012 from primary health care in the Capital Region of Denmark. SUBJECTS The population of children aged 0-6 years (n = 139,398) in the Capital Region of Denmark. MAIN OUTCOME MEASURES High use of antibiotics identified by number of antibiotic prescriptions (≥ 3 prescriptions per year) and defined daily doses (DDD). A multinomial logistic regression analysis estimating the association between high antibiotic use and parents' education, employment status, income, child's sex, and ethnic background. RESULTS Ten percent of children accounted for 25% of the total use DDD. There was a clear tendency that the risk for high antibiotic use increased as parental educational level decreased. The risk for high use was the highest among children of mothers and fathers with basic schooling ≤10 years (OR 1.60, 95% CI 1.29-1.98, and OR 1.60, 95% CI 1.34-1.91, respectively). Low income and unemployment were not associated with high antibiotic use. CONCLUSION Socioeconomic factors can only partially explain differences in antibiotic use. Further research is needed to clarify the unequal distribution of antibiotic prescribing and the association between high antibiotic use and low educational level. This would provide valuable information in the planning of strategies to promote rational use of antibiotics among children. KEY POINTS The Capital Region of Denmark has the highest rate of antibiotic prescribing in Denmark. Preschool children are among the age groups with the highest use. Ten percent of the children accounted for 25% of the total antibiotic use. Low parental educational level was associated with increased antibiotic use. Parents' income or employment status was not found to be associated with high antibiotic use.
Collapse
Affiliation(s)
- Jette Nygaard Jensen
- a Department of Clinical Microbiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Lars Bjerrum
- b Section of General Practice and Research Unit for General Practice, Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Jonas Boel
- a Department of Clinical Microbiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
- c Capital Region Pharmacy , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Jens Otto Jarløv
- a Department of Clinical Microbiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Magnus Arpi
- a Department of Clinical Microbiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| |
Collapse
|
25
|
Antibiotic prescription and food allergy in young children. Allergy Asthma Clin Immunol 2016; 12:41. [PMID: 27536320 PMCID: PMC4988015 DOI: 10.1186/s13223-016-0148-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/03/2016] [Indexed: 12/31/2022] Open
Abstract
Background To assess the relationship between any systemic antibiotic prescription within the first year of life and the presence of an ICD-9-CM diagnosis code for food allergy (FA). Methods This was a matched case–control study conducted using South Carolina Medicaid administrative data. FA cases born between 2007 and 2009 were matched to controls without FA on birth month/year, sex, race/ethnicity. Conditional logistic regression was used to model the adjusted odds ratio (aOR) of FA diagnosis. All models were adjusted for presence of asthma, wheeze, or atopic dermatitis. Results A total of 1504 cases and 5995 controls were identified. Receipt of an antibiotic prescription within the initial 12 months of life was associated with FA diagnosis in unadjusted and adjusted models (aOR 1.21; 95 % CI 1.06–1.39). Compared to children with no antibiotic prescriptions, a linear increase in the aOR was seen with increasing antibiotic prescriptions. Children receiving five or more (aOR 1.64; 95 % CI 1.31–2.05) antibiotic prescriptions were significantly associated with FA diagnosis. The strongest association was noted among recipients of cephalosporin and sulfonamide antibiotics in both unadjusted and adjusted models. Conclusions Receipt of antibiotic prescription in the first year of life is associated with FA diagnosis code in young children after controlling for common covariates. Multiple antibiotic prescriptions are more strongly associated with increases in the odds of FA diagnosis.
Collapse
|
26
|
Broides A, Bereza O, Lavi-Givon N, Fruchtman Y, Gazala E, Leibovitz E. Parental acceptability of the watchful waiting approach in pediatric acute otitis media. World J Clin Pediatr 2016; 5:198-205. [PMID: 27170930 PMCID: PMC4857233 DOI: 10.5409/wjcp.v5.i2.198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/01/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine parental knowledge about acute otitis media (AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting (WW) approach in primary care settings in southern Israel.
METHODS: The study was conducted in 3 primary care clinics and the pediatric emergency room of Soroka University Medical Center. Questionnaires (20 questions on education background, previous AOM experience, knowledge on antimicrobial resistance and attitude vs the WW approach) were filled by 600 parents (150 at each centers) of children < 6 years of age.
RESULTS: Mothers represented 69% of parents; 2% had an education of < 10 school years, 46% had high-school education and 17% had an academic degree. 69% parents reported previous experience with AOM and 56% thought that antibiotics represent the only treatment for AOM. Knowledge on bacterial resistance to antibiotics was reported by 57% of the parents; 86% parents were willing to accept/probably accept the WW approach for their children. Logistic regression analysis revealed a significant association between parental education and knowledge about bacterial resistance to antibiotics and that previous experience with AOM was significantly associated with reluctance to accept the WW approach. More parents with knowledge on bacterial resistance were willing to accept the WW approach compared with parents without such knowledge. No correlation was found between the education level and willingness to accept the WW approach.
CONCLUSION: A significant correlation was found between previous parental education and experience with AOM and the knowledge about antibiotic use, bacterial resistance and acceptance of the WW approach.
Collapse
|
27
|
Brennan-Jones CG, Eikelboom RH, Jacques A, Swanepoel D, Atlas MD, Whitehouse AJO, Jamieson SE, Oddy WH. Protective benefit of predominant breastfeeding against otitis media may be limited to early childhood: results from a prospective birth cohort study. Clin Otolaryngol 2016; 42:29-37. [PMID: 27037737 DOI: 10.1111/coa.12652] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the long-term effects of predominant breastfeeding on incidence of otitis media. DESIGN Prospective birth cohort study. SETTING The West Australian Pregnancy Cohort (Raine) Study recruited 2900 mothers through antenatal clinics at the major tertiary obstetric hospital in Perth, Western Australia, between 1989 and 1992. PARTICIPANTS In total, 2237 children participated in a 6-year cohort follow-up, and a subset of 1344 were given ear and hearing assessments. MAIN OUTCOME MEASURES OM diagnosis at 6 years of age (diagnosed by low-compliance tympanograms, 0-0.1 mmho). This was compared to OM diagnosed at the 3-year cohort follow-up using parent-report measures. Main exposure measures were duration of predominant breastfeeding (defined as the age other milk was introduced) and duration of partial (any) breastfeeding (defined as the age breastfeeding was stopped). RESULTS There was a significant, independent association between predominant breastfeeding (OR = 1.33 [1.04, 1.69]; P = 0.02) and OM, and breastfeeding duration (OR = 1.35 [1.08, 1.68]; P = 0.01) with OM at 3 years of age. However, at 6 years of age, this relationship was no longer statistically significant (predominant breastfeeding OR = 0.78 [0.48, 1.06]; P = 0.09; duration of breastfeeding, OR = 1.34 [0.81, 2.23]; P = 0.25). CONCLUSIONS Our findings are in line with a number of epidemiological studies which show a positive association between breastfeeding and OM in early childhood. However, the long-term follow-up of these children revealed that by 6 years of age, there was no significant influence of breastfeeding on presence of OM. These results suggest that the protective effect of predominant breastfeeding for at least 6 months does not extend to school-age children, where other social and environmental factors may be stronger predictors of OM.
Collapse
Affiliation(s)
- C G Brennan-Jones
- Ear Science Institute Australia, Subiaco, WA, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Crawley, WA, Australia
| | - R H Eikelboom
- Ear Science Institute Australia, Subiaco, WA, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Crawley, WA, Australia.,Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - A Jacques
- Telethon Kids Institute, The University of Western Australia, Crawley, WA, Australia.,School of Population Health, The University of Western Australia, Crawley, WA, Australia
| | - D Swanepoel
- Ear Science Institute Australia, Subiaco, WA, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Crawley, WA, Australia.,Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - M D Atlas
- Ear Science Institute Australia, Subiaco, WA, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Crawley, WA, Australia
| | - A J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Crawley, WA, Australia
| | - S E Jamieson
- Telethon Kids Institute, The University of Western Australia, Crawley, WA, Australia
| | - W H Oddy
- Telethon Kids Institute, The University of Western Australia, Crawley, WA, Australia
| |
Collapse
|
28
|
Lau L, Mick P, Venekamp RP, Schilder AGM, Nunez DA. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd012017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Loretta Lau
- Western Sussex Hospitals NHS Foundation Trust; Worthing UK
| | - Paul Mick
- University of British Columbia; Division of Otolaryngology Head & Neck Surgery; Vancouver BC Canada
| | - Roderick P Venekamp
- University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care & Department of Otorhinolaryngology; Heidelberglaan 100 Utrecht Netherlands 3508 GA
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College London; evidENT, Ear Institute; 330 Grays Inn Road London UK WC1X 8DA
| | - Desmond A Nunez
- University of British Columbia; Division of Otolaryngology Head & Neck Surgery; Vancouver BC Canada
| |
Collapse
|
29
|
Yang LY, Lynn AM, Chen TJ. Ambulatory Care Visits to Pediatricians in Taiwan: A Nationwide Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:14043-54. [PMID: 26540064 PMCID: PMC4661631 DOI: 10.3390/ijerph121114043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/24/2015] [Accepted: 10/28/2015] [Indexed: 12/30/2022]
Abstract
Pediatricians play a key role in the healthy development of children. Nevertheless, the practice patterns of pediatricians have seldom been investigated. The current study analyzed the nationwide profiles of ambulatory visits to pediatricians in Taiwan, using the National Health Insurance Research Database. From a dataset that was randomly sampled one out of every 500 records among a total of 309,880,000 visits in 2012 in the country, 9.8% (n = 60,717) of the visits were found paid to pediatricians. Children and adolescents accounted for only 69.3% of the visits to pediatricians. Male pediatricians provided 80.5% of the services and the main workforces were those aged 40-49 years. The most frequent diagnoses were respiratory tract diseases (64.7%) and anti-histamine agents were prescribed in 48.8% of the visits to pediatricians. Our detailed results could contribute to evidence-based discussions on health policymaking.
Collapse
Affiliation(s)
- Ling-Yu Yang
- Department of Pediatrics, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 112, Taiwan.
- Department of Medical Education, Taipei Veterans General Hospital, No. 201, Section 2, Shi-Pai Rd., Taipei 112, Taiwan.
| | - An-Min Lynn
- Division of Family Medicine, National Yang-Ming University Hospital, No. 152, Xinmin Rd., Yilan City, Yilan County 260, Taiwan.
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shi-Pai Rd., Taipei 112, Taiwan.
- Department of Family Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 112, Taiwan.
| |
Collapse
|
30
|
Abstract
Acute otitis media (AOM) is a common problem facing general practitioners, paediatricians and otolaryngologists. This article reviews the aetiopathogenesis, epidemiology, presentation, natural history, complications and management of AOM. The literature was reviewed by using the PubMed search engine and entering a combination of terms including 'AOM', 'epidemiology' and 'management'. Relevant articles were identified and examined for content. What is the take-home message? AOM is a very common problem affecting the majority of children at least once and places a large burden on health care systems throughout the world. Although symptomatic relief is often enough for most children, more severe and protracted cases require treatment with antibiotics, especially in younger children.
Collapse
Affiliation(s)
- Helen Atkinson
- Department of Otolaryngology, Head and Neck Surgery, York Teaching Hospitals NHS Foundations Trust , York , UK
| | | | | |
Collapse
|
31
|
Cabral C, Lucas PJ, Ingram J, Hay AD, Horwood J. “It's safer to …” parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies. Soc Sci Med 2015; 136-137:156-64. [DOI: 10.1016/j.socscimed.2015.05.027] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
32
|
Han E, Chae SM, Kim NS, Park S. Effects of pharmaceutical cost containment policies on doctors' prescribing behavior: Focus on antibiotics. Health Policy 2015; 119:1245-54. [PMID: 26119997 DOI: 10.1016/j.healthpol.2015.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 05/08/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We analyzed the effect of the outpatient prescription incentive program and price cuts of listed medicines in South Korea on prescription drug expenditures and prescription behaviors, focusing on antibiotics for the most common infectious diseases. METHODS We used the National Health Insurance claims data from January 1, 2009 through December 31, 2012. For 1625 primary clinics randomly sampled, we included all claims with principal diagnoses of acute upper respiratory tract infections (URTIs, J00-J06), acute lower respiratory tract infections (LRTIs, J20-J22), or otitis media (H65, H66). An interrupted time-series analysis was conducted. RESULTS Pharmaceutical spending per claim dropped immediately after the outpatient prescription incentive program only for otitis media (adults), but the secular trend shifted downward after the incentive program for all target diseases. The incentive program lowered the trend of antibiotic prescribing rate in otitis media (adults). The program was associated with an increase of the number of antibiotics prescribed in URTI (adults) and LRTI (children) and decrease in otitis media (adults). The broad markdown of drug prices reduced pharmaceutical expenditures immediately for all diseases, but without lasting effect. CONCLUSION The direct financial incentives to physicians to reduce in prescription spending had the intended effect over time and can be an important tool to improve pharmaceutical spending management.
Collapse
Affiliation(s)
- Euna Han
- College of Pharmacy, Yonsei Institute for Pharmaceutical Research, Yonsei University, Republic of Korea
| | - Su-Mi Chae
- Korea Institute for Health and Social Affairs, Republic of Korea
| | - Nam-Soon Kim
- Korea Institute for Health and Social Affairs, Republic of Korea
| | - Sylvia Park
- Korea Institute for Health and Social Affairs, Republic of Korea.
| |
Collapse
|
33
|
Antibiotic use before chemotherapy: a risk factor for developing neutropenic colitis in children with leukemia. J Pediatr Hematol Oncol 2015; 37:121-7. [PMID: 25089604 DOI: 10.1097/mph.0000000000000227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been shown that the use of antimicrobials is a determinant that favors intestinal dysbiosis. The objective of this study is to establish the association between the previous use of antimicrobials and the development of neutropenic colitis (NC). METHODS A case-control study was carried out with subjects diagnosed with acute lymphoblastic leukemia from 2004 to July 2013. They were identified by cross-referencing the databases from the computing area and the records from the pediatric hematology section. Cases were children with neutropenia and fever, abdominal distension and pain, diarrhea or constipation, and ultrasonography or computed tomography showing an intestinal wall thickness of ≥4 mm. Controls were children with acute lymphoblastic leukemia with neutropenia and fever, with or without gastrointestinal symptomatology, but without images of NC. RESULTS Thirty-eight cases and 75 controls were included. The factors associated with the development of NC were severe neutropenia (odds ratio [OR], 12.4; 95% confidence interval [CI], 3-51; P=0.00001), the use of antimicrobials for >10 days, within the month previous to the appearance of NC (OR, 12.4; 95% CI, 3-51; P=0.00001), and use of doxorubicin (OR, 5.43, 95% CI, 2.1-13.8, P=0.00004). In particular, the risk of developing CN was 3.46 (95% CI, 0.88-14; P=0.04) when ceftriaxone was used. CONCLUSIONS The use of antimicrobials during >10 days before the administration of chemotherapy is a risk factor for developing NC, along with other factors previously studied.
Collapse
|
34
|
Al-Balushi K, Al-Ghafri F, Al-Sawafi F, Al-Zakwani I. Antibiotic prescribing trends in an omani paediatric population. Sultan Qaboos Univ Med J 2014; 14:e495-e499. [PMID: 25364552 PMCID: PMC4205061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 03/05/2014] [Accepted: 05/01/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate antibiotic prescribing patterns for paediatric patients at Sultan Qaboos University Hospital (SQUH), a tertiary care hospital in Muscat, Oman. METHODS This retrospective cross-sectional study included all 1,186 prescriptions issued for 499 patients at the paediatric outpatient clinic and paediatric inpatient ward at SQUH between March and May 2012. RESULTS Of the 499 patients, 138 (27.6%) were prescribed a total of 28 different antibiotics. A total of 185 (15.6%) antibiotic prescriptions were issued among the total drug prescriptions. Preschool children aged 0-6 years were prescribed antibiotics most frequently (n = 110). Co-amoxiclav was the most commonly prescribed antibiotic in both inpatients and outpatients (27.0% and 33.9%, respectively), followed by cefuroxime in inpatients (13.5%) and azithromycin in outpatients (18.6%). Co-amoxiclav was the most commonly prescribed antibiotic in both 0-6 (31.3%) and 7-11 (23.3%) year-olds, while cefuroxime was most commonly prescribed in children ≥12 years old (25.0%). CONCLUSION Antibiotic prescription patterns in this population were similar to those in North America, Europe and Asia. To confirm the findings of this study, further research on antibiotic prescription trends across the wider paediatric population of Oman should be initiated.
Collapse
Affiliation(s)
- Khalid Al-Balushi
- Department of Pharmacology & Clinical Pharmacy, Sultan Qaboos University, Muscat, Oman
| | - Fatma Al-Ghafri
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Fatma Al-Sawafi
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, Sultan Qaboos University, Muscat, Oman
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman
| |
Collapse
|
35
|
Chiappini E, Mazzantini R, Bruzzese E, Capuano A, Colombo M, Cricelli C, Di Mauro G, Esposito S, Festini F, Guarino A, Miniello VL, Principi N, Marchisio P, Rafaniello C, Rossi F, Sportiello L, Tancredi F, Venturini E, Galli L, de Martino M. Rational use of antibiotics for the management of children's respiratory tract infections in the ambulatory setting: an evidence-based consensus by the Italian Society of Preventive and Social Pediatrics. Paediatr Respir Rev 2014; 15:231-6. [PMID: 24666567 DOI: 10.1016/j.prrv.2013.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 11/30/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Several guidelines for the management of respiratory tract infections in children are available in Italy, as well as in other European countries and the United States of America. However, poor adherence to guidelines and the sustained inappropriate use of antibiotics have been reported. In the outpatient setting, almost half of antibiotics are prescribed for the treatment of common respiratory tract infections. In Italy the antibiotic prescription rate is significantly higher than in other European countries, such as Denmark or the Netherlands, and also the levels of antibiotic resistance for a large variety of bacteria are higher. Therefore, the Italian Society of Preventive and Social Paediatrics organised a consensus conference for the treatment of respiratory tract infections in children to produce a brief, easily readable, evidence-based document. METHODS The conference method was used, according to the National Institute of Health and the National Plan Guidelines. A literature search was performed focusing on the current guidelines for the treatment of airway infections in children aged 1 month-18 years in the ambulatory setting. RESULTS Recommendations for the treatment of acute pharyngitis, acute otitis media, sinusitis, and pneumonia have been summarized. Conditions for which antibiotic treatment should not be routinely prescribed have been highlighted. CONCLUSION This evidence-based document is intended to accessible to primary care pediatricians and general practice physicians in order to make clinical practice uniform, in accordance with the recommendations of the current guidelines.
Collapse
Affiliation(s)
- Elena Chiappini
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Rachele Mazzantini
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | | | - Claudio Cricelli
- Health Search Institute, Italian College of General Practitioners, Florence, Italy
| | - Giuseppe Di Mauro
- President Italian Society of Preventive and Social Pediatrics Primary care Pediatrician, Caserta, Italy
| | - Susanna Esposito
- Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Filippo Festini
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples
| | | | - Nicola Principi
- Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Concetta Rafaniello
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | | | - Elisabetta Venturini
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy
| | | |
Collapse
|
36
|
Gidengil C, Mangione-Smith R, Bailey LC, Cawthon ML, McGlynn EA, Nakamura MM, Schiff J, Schuster MA, Schneider EC. Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers of excellence in measure development. Acad Pediatr 2014; 14:S76-81. [PMID: 25169462 DOI: 10.1016/j.acap.2014.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 06/08/2014] [Accepted: 06/18/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to explore the claims data-related issues relevant to quality measure development for Medicaid and the Children's Health Insurance Program (CHIP), illustrating the challenges encountered and solutions developed around 3 distinct performance measure topics: care coordination for children with complex needs, quality of care for high-prevalence conditions, and hospital readmissions. METHODS Each of 3 centers of excellence presents an example that illustrates the challenges of using claims data for quality measurement. RESULTS Our Centers of Excellence in pediatric quality measurement used innovative methods to develop algorithms that use Medicaid claims data to identify children with complex needs; overcome some shortcomings of existing data for measuring quality of care for common conditions such as otitis media; and identify readmissions after hospitalizations for lower respiratory infections. CONCLUSIONS Our experience constructing quality measure specifications using claims data suggests that it will be challenging to measure key quality of care constructs for Medicaid-insured children at a national level in a timely and consistent way. Without better data to underpin pediatric quality measurement, Medicaid and CHIP will have difficulty using some existing measures for accountability, value-based purchasing, and quality improvement both across states and within states.
Collapse
Affiliation(s)
- Courtney Gidengil
- RAND Corporation, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Wash; Seattle Children's Research Institute, Seattle, Wash
| | | | - Mary Lawrence Cawthon
- Research and Data Analysis Division, Washington Department of Social and Health Services, Olympia, Wash
| | - Elizabeth A McGlynn
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, Calif
| | - Mari M Nakamura
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Jeffrey Schiff
- Office of the Medicaid Medical Director, Minnesota Department of Human Services, St Paul, Minn
| | - Mark A Schuster
- Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Eric C Schneider
- RAND Corporation, Boston, Mass; Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| |
Collapse
|
37
|
Cabral C, Ingram J, Hay AD, Horwood J. "They just say everything's a virus"--parent's judgment of the credibility of clinician communication in primary care consultations for respiratory tract infections in children: a qualitative study. PATIENT EDUCATION AND COUNSELING 2014; 95:248-253. [PMID: 24569180 DOI: 10.1016/j.pec.2014.01.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 01/16/2014] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate parents' experiences and views of clinician communication during primary care consultations for respiratory tract infections (RTIs) in children under 12. METHODS Semi-structured interviews with 30 parents who had recently consulted for RTI in their child. Purposive sampling was used to interview parents from a range of socio-economic areas. RESULTS Parents critically assess the credibility of primary care clinician diagnosis and treatment recommendations based on their perception of the medical evaluation and how well their concerns and expectations have been addressed. A "viral" diagnosis could be perceived as trivializing, particularly when contradicting the parent's perception of severity. Parents expected advice on symptomatic treatment and felt frustrated by 'no treatment' recommendations. Parents commonly reported safety netting advice which was too vague to be useful. CONCLUSION Parents' perception of the credibility of the diagnosis and treatment recommendations is influenced both by their expectations and the effectiveness of clinician communication. Opportunities are being missed to inform parents about symptomatic care and when to consult for children with RTIs. PRACTICE IMPLICATIONS Clinicians should tailor diagnostic explanations to parental expectations and concerns and address the symptoms of significance to parents. Clinicians should provide advice about symptom relief and more precise safety netting advice.
Collapse
Affiliation(s)
- Christie Cabral
- Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social & Community Medicine, University of Bristol, Bristol, UK.
| | - Jenny Ingram
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social & Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
38
|
Cabral C, Horwood J, Hay AD, Lucas PJ. How communication affects prescription decisions in consultations for acute illness in children: a systematic review and meta-ethnography. BMC FAMILY PRACTICE 2014; 15:63. [PMID: 24708839 PMCID: PMC4234398 DOI: 10.1186/1471-2296-15-63] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022]
Abstract
Background Communication within primary care consultations for children with acute illness can be problematic for parents and clinicians, with potential misunderstandings contributing to over–prescription of antibiotics. This review aimed to synthesise the evidence in relation to communication and decision making in consultations for children with common acute illness. Methods A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, SSCI, SIGLE, Dissertation Express and NHS economic evaluation databases was conducted. Studies of primary care settings in high income countries which made direct observations of consultations and reported qualitative data were included. Included studies were appraised using the process recommended by the Cochrane Qualitative Methods Group. Credibility was assessed as high for most studies but transferability was usually assessed low or unclear. Data were synthesised using a meta–ethnographic approach. Results Thirty–five papers and 2 theses reporting on 13 studies were included, 7 of these focussed on children with respiratory tract infections (RTI) and the remaining 6 included children with any presenting illness. Parent communication focussed on their concerns and information needs, whereas clinician communication focussed on diagnosis and treatment decisions. During information exchanges, parents often sought to justify the need for the consultation, while clinicians frequently used problem minimising language, resulting in parents and clinicians sometimes talking at cross–purposes. In the context of RTIs, a range of parent communication behaviours were interpreted by clinicians as indicating an expectation for antibiotics; however, most were ambiguous and could also be interpreted as raising concerns or requests for further information. The perceived expectation for antibiotics often changed clinician decision making into clinician–parent negotiation. Conclusions Misunderstandings occurred due to parents and clinicians talking at cross purposes about the ‘seriousness’ of the illness and because parents’ expressions of concern or requests for additional information were sometimes perceived as a challenge to the clinicians’ diagnosis or treatment decision. This modifiable problem may be an important contribution to the unnecessary and unwanted prescribing of antibiotics. Primary care clinicians should be offered training to understand parent communication primarily as expressions of concern or attempts at understanding and always to check rather than infer parental expectations.
Collapse
Affiliation(s)
- Christie Cabral
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK.
| | | | | | | |
Collapse
|
39
|
Abstract
Otitis media is a major cause of morbidity in 80% of all children less than 3 years of age and often goes undiagnosed in the general population. There is evidence to suggest that the incidence of otitis media is increasing. The major cause of otitis media is infection of the middle ear with microbes from the nasopharynx. The anatomical orientation of the eustachian tube, in association with a number of risk factors, predisposes infants and young children to the infection. Bacteria are responsible for approximately 70% of cases of acute otitis media, with Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Moraxella catarrhalis predominating as the causative agents. The respiratory viruses, respiratory syncytial virus, rhinovirus, parainfluenza and influenza, account for 30% of acute otitis media cases. Over the past decade, there has been a profound increase in the reported resistance to antibiotics, which, with increased disease burden, has focussed attention on vaccine development for otitis media. A polymicrobial formulation containing antigens from all major pathogens would have the greatest potential to deliver a sustained reduction in the disease burden globally. The disappointing outcomes for otitis media seen with the polysaccharide pneumococcal conjugate vaccine have raised major challenges for the vaccination strategy. Clearly, more knowledge is required concerning immune mechanisms in the middle ear, as well as vaccine formulations containing antigens that are more representative of the polymicrobial nature of the disease. Antigens that have been extensively tested in animal models are now available for testing in human subjects.
Collapse
Affiliation(s)
- Allan W Cripps
- Griffith University, School of Medicine, Gold Coast Campus, PMB 50, Gold Coast, MC, QLD, 9726, Australia.
| | | |
Collapse
|
40
|
Abstract
BACKGROUND An increase in severe complications to otitis media is a potential threat to antibiotic restrictions and is difficult to measure due to its low-prevalent nature. Easily accessible indicators sensitive to illness change are needed to benchmark the judicious use of antibiotics. OBJECTIVE To investigate whether there has been a constant increase of hospital admissions for acute otitis media after the year 2000. METHODS Registry-based study with complete data on hospitalization for acute otitis media and acute mastoiditis in Norway during 1999 to 2006. RESULTS Mean incidence rate for acute otitis media hospitalization was 22.4 per 10,000 children and peak incidence in the second year of life 52.2 per 10,000 children. Corresponding mean incidence rate and peak incidence for acute mastoiditis were 1.5 and 3.5 per 10,000 children in the second year of life, respectively. There was a gradient increase of the incidence rates of acute otitis media hospitalization from the year 2000 to 2006 considering the Poisson regression model with a significant test of linear trend. CONCLUSIONS Hospital admission for acute otitis media is prevalent enough to be a useful marker for otitis media severity and its distribution proportionate to that of acute mastoiditis.
Collapse
|
41
|
Baer G, Baumann P, Buettcher M, Heininger U, Berthet G, Schäfer J, Bucher HC, Trachsel D, Schneider J, Gambon M, Reppucci D, Bonhoeffer JM, Stähelin-Massik J, Schuetz P, Mueller B, Szinnai G, Schaad UB, Bonhoeffer J. Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial. PLoS One 2013; 8:e68419. [PMID: 23936304 PMCID: PMC3735552 DOI: 10.1371/journal.pone.0068419] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/25/2013] [Indexed: 01/31/2023] Open
Abstract
Background Antibiotics are overused in children and adolescents with lower respiratory tract infection (LRTI). Serum-procalcitonin (PCT) can be used to guide treatment when bacterial infection is suspected. Its role in pediatric LRTI is unclear. Methods Between 01/2009 and 02/2010 we randomized previously healthy patients 1 month to 18 years old presenting with LRTI to the emergency departments of two pediatric hospitals in Switzerland to receive antibiotics either according to a PCT guidance algorithm established for adult LRTI or standard care clinical guidelines. In intention-to-treat analyses, antibiotic prescribing rate, duration of antibiotic treatment, and number of days with impairment of daily activities within 14 days of randomization were compared between the two groups. Results In total 337 children, mean age 3.8 years (range 0.1–18), were included. Antibiotic prescribing rates were not significantly different in PCT guided patients compared to controls (OR 1.26; 95% CI 0.81, 1.95). Mean duration of antibiotic exposure was reduced from 6.3 to 4.5 days under PCT guidance (−1.8 days; 95% CI −3.1, −0.5; P = 0.039) for all LRTI and from 9.1 to 5.7 days for pneumonia (−3.4 days 95% CI −4.9, −1.7; P<0.001). There was no apparent difference in impairment of daily activities between PCT guided and control patients. Conclusion PCT guidance reduced antibiotic exposure by reducing the duration of antibiotic treatment, while not affecting the antibiotic prescribing rate. The latter may be explained by the low baseline prescribing rate in Switzerland for pediatric LRTI and the choice of an inappropriately low PCT cut-off level for this population. Trial Registration Controlled-Trials.com ISRCTN17057980 ISRCTN17057980
Collapse
Affiliation(s)
- Gurli Baer
- Department of Pediatrics, University Basel, Basel, Switzerland
| | | | | | - Ulrich Heininger
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Gerald Berthet
- Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland
| | - Juliane Schäfer
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Heiner C. Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Daniel Trachsel
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Jacques Schneider
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Muriel Gambon
- University Children's Hospital Basel, Basel, Switzerland
| | - Diana Reppucci
- University Children's Hospital Basel, Basel, Switzerland
| | | | | | - Philipp Schuetz
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Beat Mueller
- Department of Internal Medicine, Kantonsspital Aarau, Basel, Switzerland
| | - Gabor Szinnai
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Urs B. Schaad
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Jan Bonhoeffer
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
- * E-mail:
| |
Collapse
|
42
|
Elshout G, van Ierland Y, Bohnen AM, de Wilde M, Oostenbrink R, Moll HA, Berger MY. Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study. Br J Gen Pract 2013; 63:e437-44. [PMID: 23834880 PMCID: PMC3693800 DOI: 10.3399/bjgp13x669158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/29/2012] [Accepted: 02/05/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Although fever in children is often self-limiting, antibiotics are frequently prescribed for febrile illnesses. GPs may consider treating serious infections by prescribing antibiotics. AIM To examine whether alarm signs and/or symptoms for serious infections are related to antibiotic prescription in febrile children in primary care. DESIGN AND SETTING Observational cohort study involving five GP out-of-hours services. METHOD Clinical information was registered and manually recoded. Children (<16 years) with fever having a face-to-face contact with a GP were included. Children who were already using antibiotics or referred to secondary care were excluded. The relation between alarm signs and/or symptoms for serious infections and antibiotic prescription was tested using multivariate logistic regression. RESULTS Of the 8676 included patients (median age 2.4 years), antibiotics were prescribed in 3167 contacts (36.5%). Patient characteristics and alarm signs and/or symptoms positively related to antibiotic prescription were: increasing age (odds ratio [OR] = 1.03; 95% confidence interval [95% CI] = 1.02 to 1.05), temperature measured by GP (OR = 1.72; 95% CI = 1.59 to 1.86), ill appearance (OR = 3.93; 95% CI = 2.85 to 5.42), being inconsolable (OR = 2.27; 95% CI = 1.58 to 3.22), shortness of breath (OR = 2.58; 95% CI = 1.88 to 3.56), duration of fever (OR = 1.31; 95% CI = 1.26 to 1.35). Negative associations were found for neurological signs (OR = 0.45; 95% CI = 0.27 to 0.76), signs of urinary tract infection (OR = 0.63; 95% CI = 0.49 to 0.82), and vomiting and diarrhoea (OR = 0.65; 95% CI = 0.57 to 0.74). These variables explained 19% of the antibiotic prescriptions. CONCLUSION Antibiotics are often prescribed for febrile children. These data suggest that treatment of a supposed serious bacterial infection is a consideration of GPs. However, the relatively low explained variation indicates that other considerations are also involved.
Collapse
Affiliation(s)
- Gijs Elshout
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
43
|
Lis DO, Górny RL. Haemophilus influenzae as an airborne contamination in child day care centers. Am J Infect Control 2013; 41:438-42. [PMID: 22980511 DOI: 10.1016/j.ajic.2012.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 05/24/2012] [Accepted: 05/24/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to assess the exposure of children to airborne Haemophilus influenzae in day care centers. METHODS Air samples were taken using an Andersen impactor in 32 rooms designed for children stay. The concentrations of airborne bacteria were calculated as colony forming units (CFU) (growing on trypticase soy agar) per cubic meter of air (CFU/m(3)). The compositions of bioaerosol were determined on blood trypticase soy agar and Haemophilus selective agar. Isolated strains were identified using API NH strips and apiweb software. The antibiotic resistance of H influenzae strains was determined by the disk diffusion method. RESULTS Compared with the proposed criteria for microbiologic quality of indoor air, the rooms were characterized by the very high bacterial contamination of the air. The prevailing component of bacterial aerosol was gram-positive cocci. Airborne H influenzae strains were found in 25% of the investigated rooms and were mostly classified as biotype II (33%). CONCLUSION It may be accepted that the exposure to airborne H influenzae is typical of child day care centers in contrast to indoor environments with older population. Child day care center contribute to the expansion of H influenzae in human population via air. Generally, airborne H influenzae isolates from the investigated child day care centers were susceptible to older antibiotics such as ampicillin and amoxicillin-clavulanic acid.
Collapse
Affiliation(s)
- Danuta O Lis
- Department of Biohazards and Immunoallergology, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland.
| | | |
Collapse
|
44
|
Forrest CB, Fiks AG, Bailey LC, Localio R, Grundmeier RW, Richards T, Karavite DJ, Elden L, Alessandrini EA. Improving adherence to otitis media guidelines with clinical decision support and physician feedback. Pediatrics 2013; 131:e1071-81. [PMID: 23478860 DOI: 10.1542/peds.2012-1988] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the effects of electronic health record-based clinical decision support (CDS) and physician performance feedback on adherence to guidelines for acute otitis media (AOM) and otitis media with effusion (OME). METHODS We conducted a factorial-design cluster randomized trial with primary care practices (n = 24) as the unit of randomization and visits as the unit of analysis. Between December 2007 and September 2010, data were collected from 139,305 otitis media visits made by 55,779 children aged 2 months to 12 years. When activated, the CDS system provided guideline-based recommendations individualized to the patient's history and presentation. Monthly physician feedback reported adherence to guideline-based care, changes over time, and comparisons to others in the practice and network. RESULTS Comprehensive care (all recommended guidelines were adhered to) was accomplished for 15% of AOM and 5% of OME visits during the baseline period. The increase from baseline to intervention periods in adherence to guidelines was larger for CDS compared with non-CDS visits for comprehensive care, pain treatment, adequate diagnostic evaluation for OME, and amoxicillin as first-line therapy for AOM. Although performance feedback was associated with improved antibiotic prescribing for AOM and pain treatment, the joint effects of CDS and feedback on guideline adherence were not additive. There was marked variation in use of the CDS system, ranging from 5% to 45% visits across practices. CONCLUSIONS Clinical decision support and performance feedback are both effective strategies for improving adherence to otitis media guidelines. However, combining the 2 interventions is no better than either delivered alone.
Collapse
Affiliation(s)
- Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Lass J, Odlind V, Irs A, Lutsar I. Antibiotic prescription preferences in paediatric outpatient setting in Estonia and Sweden. SPRINGERPLUS 2013; 2:124. [PMID: 23667800 PMCID: PMC3647088 DOI: 10.1186/2193-1801-2-124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 03/08/2013] [Indexed: 12/23/2022]
Abstract
Aims of the study were to compare the paediatric outpatient antibiotic use in two countries with low overall antibiotic consumption and antibacterial resistance levels - Sweden and Estonia - and to describe the adherence to Estonian treatment guideline. All prescriptions for systemic antibiotics for children less than 18 years during 2007 from the Swedish Prescribed Drug Register and Estonian Health Insurance Fund database were identified to conduct a descriptive drug utilisation study. The total paediatric antibiotic use was 616 and 353 per 1000 in Estonia and Sweden, respectively. The greatest between country differences occurred in the age group 2 to 6 years -Estonian children received 1184 and Swedish children 528 prescriptions per 1000. Extended spectrum penicillin amoxicillin (189 per 1000) or its combination with beta-lactamase inhibitor (81 per 1000) and a newer macrolide clarithromycin (127 per 1000) were prescribed most often in Estonia whereas narrow spectrum penicillin phenoxymethylpenicillin (169 per 1000) and older generation macrolide erythromycin (21 per 1000) predominated in Sweden. For acute bronchitis, 17 different antibiotics (most commonly clarithromycin) were prescribed in Estonia despite the guideline recommendation not to use antibiotics. The higher rate of antibiotic use especially of extended spectrum antibiotics in Estonia compared to Sweden emphasizes the need for national activities to promote appropriate use of antibiotics while treating children, even when the overall antibiotic consumption is low.
Collapse
Affiliation(s)
- Jana Lass
- Institute of Microbiology, Tartu University, Tartu, Estonia ; Pharmacy Department, Tartu University Clinics, Tartu, Estonia
| | | | | | | |
Collapse
|
46
|
Alder SC, Trunnell EP, White GL, Lyon JL, Reading JP, Samore MH, Magill MK. Reducing Parental Demand for Antibiotics by Promoting Communication Skills. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2005.10608174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Stephen C. Alder
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| | - Eric P. Trunnell
- b Health Promotion and Education , HPER North, 250 S 1850 East Room 200, Salt Lake City , UT , 84108 , USA
| | - George L. White
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| | - Joseph L. Lyon
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| | - James P. Reading
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| | - Matthew H. Samore
- c Division of Clinical Epidemiology , School of Medicine , 30 N 1900 E RM AC226, USA
| | - Michael K. Magill
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| |
Collapse
|
47
|
Abstract
OBJECTIVES To examine the associations of antibiotic exposures during the first 2 years of life and the development of body mass over the first 7 years of life. DESIGN Longitudinal birth cohort study. SUBJECTS A total of 11 532 children born at 2500 g in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based study of children born in Avon, UK in 1991-1992. MEASUREMENTS Exposures to antibiotics during three different early-life time windows (<6 months, 6-14 months, 15-23 months), and indices of body mass at five time points (6 weeks, 10 months, 20 months, 38 months and 7 years). RESULTS Antibiotic exposure during the earliest time window (<6 months) was consistently associated with increased body mass (+0.105 and +0.083 s.d. unit, increase in weight-for-length Z-scores at 10 and 20 months, P<0.001 and P=0.001, respectively; body mass index (BMI) Z-score at 38 months +0.067 s.d. units, P=0.009; overweight OR 1.22 at 38 months, P=0.029) in multivariable, mixed-effect models controlling for known social and behavioral obesity risk factors. Exposure from 6 to 14 months showed no association with body mass, while exposure from 15 to 23 months was significantly associated with increased BMI Z-score at 7 years (+0.049 s.d. units, P=0.050). Exposures to non-antibiotic medications were not associated with body mass. CONCLUSIONS Exposure to antibiotics during the first 6 months of life is associated with consistent increases in body mass from 10 to 38 months. Exposures later in infancy (6-14 months, 15-23 months) are not consistently associated with increased body mass. Although effects of early exposures are modest at the individual level, they could have substantial consequences for population health. Given the prevalence of antibiotic exposures in infants, and in light of the growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular risks.
Collapse
Affiliation(s)
- L Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY 10016, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Trends in antibiotic prescribing in adults in Dutch general practice. PLoS One 2012; 7:e51860. [PMID: 23251643 PMCID: PMC3520879 DOI: 10.1371/journal.pone.0051860] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 11/08/2012] [Indexed: 01/12/2023] Open
Abstract
Background Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this study was to determine the antibiotic prescriptions of different antibiotic classes in general practice in relation to age. Methodology Retrospective study of 22 rural and urban general practices from the Dutch Registration Network Family Practices (RNH). Antibiotic prescribing data were extracted from the RNH database from 2000–2009. Trends over time in antibiotic prescriptions were assessed with multivariate logistic regression including interaction terms with age. Registered ADEs as a result of antibiotic prescriptions were also analyzed. Principal Findings In total 658,940 patients years were analyzed. In 11.5% (n = 75,796) of the patient years at least one antibiotic was prescribed. Antibiotic prescriptions increased for all age categories during 2000–2009, but the increase in elderly patients (>80 years) was most prominent. In 2000 9% of the patients >80 years was prescribed at least one antibiotic to 22% in 2009 (P<0.001). Elderly patients had more ADEs with antibiotics and co-medication was identified as the only independent determinant for ADEs. Conclusion/Discussion The rate of antibiotic prescribing for patients who made a visit to the GP is increasing in the Netherlands with the most evident increase in the elderly patients. This may lead to more ADEs, which might lead to higher consumption of health care and more antibiotic resistance.
Collapse
|
49
|
McConnochie KM. Development of an algorithm for the diagnosis of otitis media. Acad Pediatr 2012; 12:159-60. [PMID: 22498684 DOI: 10.1016/j.acap.2012.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Kenneth M McConnochie
- Department of Pediatrics, University of Rochester Medical Center, Box 777, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| |
Collapse
|
50
|
Abstract
Human milk provides infants with antimicrobial, anti-inflammatory, and immunomodulatory agents that contribute to optimal immune system function. The act of breastfeeding allows important bacterial and hormonal interactions between the mother and baby and impacts the mouth, tongue, swallow, and eustachian tubes. Previous meta-analyses have shown that lack of breastfeeding and less intensive patterns of breastfeeding are associated with increased risk of acute otitis media, one of the most common infections of childhood. A review of epidemiologic studies indicates that the introduction of infant formula in the first 6 months of life is associated with increased incidence of acute otitis media in early-childhood. More recent research raises the issues of how long this increased risk persists, and whether lack of breastfeeding is associated with diagnosis of otitis media with effusion. However, many studies suffer from lack of study of younger populations and imprecise definitions of infant feeding patterns. These findings suggest that measures of the association between breastfeeding history and otitis media risk are sensitive to the definition of breastfeeding used; future research is needed with more precise and consistent definitions of feeding, with attention to distinctions between direct breastfeeding and human milk feeding by bottle.
Collapse
|