1
|
Liu SS, White JM, Chao Z, Li R, Wen S, Garza A, Tang W, Ma X, Chen P, Daniel S, Bates FS, Yeo J, Calabrese MA, Yang R. A Pseudo-Surfactant Chemical Permeation Enhancer to Treat Otitis Media via Sustained Transtympanic Delivery of Antibiotics. Adv Healthc Mater 2024:e2400457. [PMID: 38738584 DOI: 10.1002/adhm.202400457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/08/2024] [Indexed: 05/14/2024]
Abstract
Chemical permeation enhancers (CPEs) represent a prevalent and safe strategy to enable noninvasive drug delivery across skin-like biological barriers such as the tympanic membrane (TM). While most existing CPEs interact strongly with the lipid bilayers in the stratum corneum to create defects as diffusion paths, their interactions with the delivery system, such as polymers forming a hydrogel, can compromise gelation, formulation stability, and drug diffusion. To overcome this challenge, differing interactions between CPEs and the hydrogel system are explored, especially those with sodium dodecyl sulfate (SDS), an ionic surfactant and a common CPE, and those with methyl laurate (ML), a nonionic counterpart with a similar length alkyl chain. Notably, the use of ML effectively decouples permeation enhancement from gelation, enabling sustained delivery across TMs to treat acute otitis media (AOM), which is not possible with the use of SDS. Ciprofloxacin and ML are shown to form a pseudo-surfactant that significantly boosts transtympanic permeation. The middle ear ciprofloxacin concentration is increased by 70-fold in vivo in a chinchilla AOM model, yielding superior efficacy and biocompatibility than the previous highest-performing formulation. Beyond improved efficacy and biocompatibility, this single-CPE formulation significantly accelerates its progression toward clinical deployment.
Collapse
Affiliation(s)
- Sophie S Liu
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, Olin Hall, Ithaca, NY, 14850, USA
- Meinig School of Biomedical Engineering, Cornell University, Weill Hall, Ithaca, NY, 14850, USA
| | - Joanna M White
- Department of Chemical Engineering and Materials Science, University of Minnesota, 421 Washington Ave., Minneapolis, MN, 55455, USA
| | - Zhongmou Chao
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, Olin Hall, Ithaca, NY, 14850, USA
| | - Ruye Li
- Department of Chemistry and Chemical Biology, Cornell University, Baker Laboratory, Ithaca, NY, 14850, USA
| | - Shuxian Wen
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, Olin Hall, Ithaca, NY, 14850, USA
| | - Ally Garza
- Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley 1201 W University Drive, Edinburg, TX, 78539, USA
| | - Wenjing Tang
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, Olin Hall, Ithaca, NY, 14850, USA
| | - Xiaojing Ma
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, Olin Hall, Ithaca, NY, 14850, USA
| | - Pengyu Chen
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, Olin Hall, Ithaca, NY, 14850, USA
| | - Susan Daniel
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, Olin Hall, Ithaca, NY, 14850, USA
| | - Frank S Bates
- Department of Chemical Engineering and Materials Science, University of Minnesota, 421 Washington Ave., Minneapolis, MN, 55455, USA
| | - Jingjie Yeo
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Upson Hall, Ithaca, NY, 14850, USA
| | - Michelle A Calabrese
- Department of Chemical Engineering and Materials Science, University of Minnesota, 421 Washington Ave., Minneapolis, MN, 55455, USA
| | - Rong Yang
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, Olin Hall, Ithaca, NY, 14850, USA
| |
Collapse
|
2
|
Moral L, Toral T, Muñoz C, Marco N, García-Avilés B, Murcia L, Forniés MJ, González MC, Canals F, Bragado E, Martínez Olmos J, García-Magán C, Moure González JD, Cortés N, Giménez M, Gómez C, Rodríguez AB, Moreno A, Lucas JM, Quevedo S, Blasco C, Aliaga Y. Direct oral challenge for immediate and non-immediate beta-lactam allergy in children: A real-world multicenter study. Pediatr Allergy Immunol 2024; 35:e14096. [PMID: 38425150 DOI: 10.1111/pai.14096] [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: 12/01/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Allergy to beta-lactam antibiotics (BLA) is frequently suspected in children, but a drug provocation test (DPT) rules it out in over 90% of cases. Direct oral DPT (DODPT), without skin or other previous tests, is increasingly been used to delabel non-immediate BLA reactions. This real-world study aimed to assess the safety and effectiveness of DODPT in children with immediate and non-immediate reactions to BLAs. METHODS Ambispective registry study in children (<15 years), attended between 2016 and 2023 for suspected BLA allergy in 15 hospitals in Spain that routinely perform DODPT. RESULTS The study included 2133 patients with generally mild reactions (anaphylaxis 0.7%). Drug provocation test with the implicated BLA was performed in 2014 patients (94.4%): 1854 underwent DODPT (86.9%, including 172 patients with immediate reactions). One hundred forty-five (7.2%) had symptoms associated with DPT, although only four reactions were severe: two episodes of anaphylaxis and two of drug-induced enterocolitis syndrome, which resolved rapidly with treatment. Of the 141 patients with mild reactions in the first DPT, a second DPT was considered in 87 and performed in 57, with 52 tolerating it without symptoms. Finally, BLA allergy was ruled out in 90.9% of the sample, confirmed in 3.4%, and remained unverified, usually due to loss to follow-up, in 5.8%. CONCLUSIONS Direct oral DPT is a safe, effective procedure even in immediate mild reactions to BLA. Many reactions observed in DPT are doubtful and require confirmation. Severe reactions are exceptional and amenable to treatment. Direct oral DPT can be considered for BLA allergy delabeling in pediatric primary care.
Collapse
Affiliation(s)
- Luis Moral
- Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | - Teresa Toral
- Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain
| | | | - Nuria Marco
- Hospital Vega Baja de Orihuela, San Bartolome, Spain
| | | | | | | | | | | | - Esther Bragado
- Hospital General Universitario Santa Lucía, Cartagena, Spain
| | | | | | | | - Nuria Cortés
- Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | - Magalí Giménez
- Hospital Sant Joan de Deu, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Catalina Gómez
- Hospital Sant Joan de Deu, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | | | - Ana Moreno
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | | |
Collapse
|
3
|
Chigome A, Ramdas N, Skosana P, Cook A, Schellack N, Campbell S, Lorenzetti G, Saleem Z, Godman B, Meyer JC. A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:1540. [PMID: 37887241 PMCID: PMC10604704 DOI: 10.3390/antibiotics12101540] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.
Collapse
Affiliation(s)
- Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Phumzile Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa;
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| |
Collapse
|
4
|
Moral L, Mori F. Drug provocation tests in children: All that glitters is not gold. Pediatr Allergy Immunol 2023; 34:e14002. [PMID: 37622259 DOI: 10.1111/pai.14002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 08/26/2023]
Abstract
A proper allergy work-up, based on the gold standard drug provocation test (DPT), usually rules out suspected drug hypersensitivity in children. These tests are generally open, given their high efficiency compared with double-blind placebo-controlled DPTs. Although their negative predictive value is excellent, no studies have calculated their positive predictive value, highly dependent on the prevalence of the disease. Most studies have found a rate of <5%-10% of true beta-lactam hypersensitivity in children. Given this low prevalence (pre-test probability), a few false-positive results can significantly reduce the estimated positive predictive value. False positives may arise from the nocebo effect during the test, including nocebo by proxy, or from observer bias, which depends on professional expertise and organizational circumstances. Some studies have found a high rate of tolerance on a second DPT in children who failed the first, but these results may be affected by the interval between the two tests, of a year or more in most cases, reflecting a loss of hypersensitivity over time. Taking into account the low rate of positive DPTs, with commonly mild reactions, we suggest confirming nonsevere positive DPTs with a second provocation performed soon after the first, especially in the case of beta-lactam antibiotics, in order to improve the diagnostic accuracy, de-label more patients, and achieve a better estimation of true drug hypersensitivity prevalence. In case of mild immediate reactions, the potential benefits of a second DPT should be carefully weighed against the risk of anaphylaxis.
Collapse
Affiliation(s)
- Luis Moral
- Pediatric Allergy and Respiratory Unit, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital, IRCCS Florence, Florence, Italy
| |
Collapse
|
5
|
Dharmapalan D, Bielicki J, Sharland M. Harmonization of Amoxicillin Dose, Duration, and Formulation for Acute Childhood Respiratory Infections. Antibiotics (Basel) 2023; 12:1138. [PMID: 37508234 PMCID: PMC10376083 DOI: 10.3390/antibiotics12071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Pediatric guidelines vary in their recommended amoxicillin dosing for common respiratory infections. It would help program delivery if there was harmonization of dosing and formulation of amoxicillin across multiple clinical respiratory infections, considering the pharmacokinetics, common targets, drug resistance, availability, cost effectiveness, and ease of administration. The World Health Organization EML AWaRe Book recommends higher dose amoxicillin given twice daily for five days for all uncomplicated respiratory infections where an antibiotic is indicated. The WHO AWaRe Book amoxicillin dosing guidance can be achieved for infants and older children using only scored 250 mg and 500 mg dispersible tablets (DTs), the WHO recommended child formulation. There is a clear need for wider availability of 250 mg/500 mg dispersible tablets of amoxicillin in both public and private health care sectors, to improve access to essential antibiotics.
Collapse
Affiliation(s)
- Dhanya Dharmapalan
- Consultant in Pediatric Infectious Diseases, Apollo Hospitals, Navi Mumbai 400614, India
| | - Julia Bielicki
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK; (J.B.); (M.S.)
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK; (J.B.); (M.S.)
| |
Collapse
|
6
|
Spoială EL, Stârcea IM, Ioniuc IK, Cozma RS, Rusu DC, Bozomitu L, Lupu VV, Iliescu Haliţchi CO, Roşu VE, Roşu ST, Gavrilovici C. Watchful Waiting in Pediatric Acute Otitis Media: A Real Practice Approach or an Intangible Desideratum? Medicina (B Aires) 2023; 59:medicina59030520. [PMID: 36984521 PMCID: PMC10053714 DOI: 10.3390/medicina59030520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
Acute otitis media (AOM) in children is one of the leading causes of health care visits and antibiotic prescriptions worldwide. The overall aim of the current study is twofold: 1. to analyze and discuss the antibiotic prescription patterns in AOM in children without complications or risk factors and 2. to assess to what extent the watchful-waiting approach is a real practice or a mere desideratum. We performed an electronic search in the PubMed and Embase databases from 2013 to 2023 to capture original research studies investigating antibiotic prescribing patterns for AOM in children. Among the 12 papers included in the analysis, the antibiotic prescription rate ranged from 44.8% to 98%. Our study reveals similarities regarding the use of amoxicillin as a first-line antibiotic in pediatric AOM, but also discrepancies in the watchful-waiting approach attitude and in the choice of second or third-line antimicrobial agents. The proportion of cases managed with the watchful-waiting approach ranged from 7.5% (Australia) to 55.2% (Finland). Denmark was the only country reporting penicillin V as a first-choice regimen for children with AOM, which fulfils the guidelines’ recommendations. The most unsatisfying rate of amoxicillin use was recorded in Japan, contrary to the recommendations of local guidelines. The use of quinolones was reported in two out of twelve studies, with the highest proportion in Japan, where tosufloxacin was used in 21.4% of the total number of cases. The duration of the antibiotic regimens was analyzed in three out of twelve papers. Since global antibiotic overuse contributes to the emergence of antibiotic resistant bacteria, new strategies are needed to increase the rate of watchful waiting and to promote the judicious use of antibiotics.
Collapse
Affiliation(s)
- Elena-Lia Spoială
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iuliana Magdalena Stârcea
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (I.M.S.); (V.V.L.)
| | - Ileana Katerina Ioniuc
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Romică Sebastian Cozma
- ENT Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Daniela Carmen Rusu
- ENT Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Laura Bozomitu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (I.M.S.); (V.V.L.)
| | | | - Vasile Eduard Roşu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Solange Tamara Roşu
- Nursing Departmentsolange, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Gavrilovici
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| |
Collapse
|
7
|
Sanner JR, Jain K, Williams J, Hurley MN. Antibiotics for chronic pulmonary infection in children with a neurodisability (neurodevelopmental disorder). Cochrane Database Syst Rev 2023; 2:CD013813. [PMID: 36757320 PMCID: PMC9909774 DOI: 10.1002/14651858.cd013813.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND 'Neurodisability' refers to a group of conditions that result primarily from a neurological problem (e.g. cerebral palsy), neuromuscular problem (e.g. a muscular dystrophy) or developmental problems (e.g. developmental impairment, Down syndrome). Children and young people with these conditions may have similar problems with mobility, feeding and airway clearance. Chest and breathing problems (including pulmonary infections) are commonly experienced by children and young people with neurodisabilities and are often a cause for them requiring hospital care. For those who are unable to completely clear their airway of secretions, or have frequent infections, pulmonary infections may not be able to be completely eradicated and therefore become chronic. It is unclear what treatment is best for children and young people in this position. OBJECTIVES To assess the effectiveness and adverse effects of antibiotic treatment for chronic pulmonary infection in children and young people living with a neurodisability, including quality-of-life measures, effects on hospitalisation and healthcare contacts. SEARCH METHODS We searched the Cochrane Airways Trials Register, Cochrane Acute Respiratory Infections Group Register of Trials (CARIGRT), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), OpenGrey (www.opengrey.eu) and three trials registries up to 8 February 2022. Additionally, we identified related systematic reviews through Epistemonikos.org (8 February 2022) and searched reference lists of these. SELECTION CRITERIA All randomised controlled trials of antibiotic therapy for chronic pulmonary infection in children and young people up to the age of 18 living with a neurodisability were eligible. DATA COLLECTION AND ANALYSIS Two independent review authors screened results of the searches against predetermined inclusion criteria, resolving any discrepancies by discussion. MAIN RESULTS We identified a total of 1968 independent records through our searches, of which we assessed six full-text articles for eligibility. We identified one ongoing study as well as one related substudy but did not identify any completed studies eligible for inclusion in this systematic review. AUTHORS' CONCLUSIONS The findings of this systematic review highlight a lack of evidence in the antibiotic treatment of chronic pulmonary infection in children and young people up to the age of 18 living with a neurodisability. Further research examining this topic is therefore required.
Collapse
Affiliation(s)
- Juliane Rf Sanner
- Department of Family Health, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kamini Jain
- Leicester Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jane Williams
- Department of Family Health, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew N Hurley
- Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
8
|
Nano-silver composite antibacterial gel in the treatment of otitis media. APPLIED NANOSCIENCE 2022. [DOI: 10.1007/s13204-022-02729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
|
9
|
Taha A, Adeline F, Taha MK, Deghmane AE. Haemophilus influenzae drug resistance in France from 2017 to 2021: consideration for treatment of otitis media. J Glob Antimicrob Resist 2022; 31:222-227. [PMID: 36195280 DOI: 10.1016/j.jgar.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Haemophilus influenzae is a prevalent agent of respiratory infections, including acute otitis media (AOM), that lead to high antibiotic prescription and may contribute to the development of bacterial resistance to antibiotics. The objective of this work was to describe and analyse antibiotic resistance of H. influenzae from 2017 to 2021 in France. METHODS We characterized H. influenzae isolates transmitted to the French national reference centre for H. influenzae between 2017 and 2021. We included all the 608 non-invasive respiratory isolates. Resistance rates to the main antibiotics were described. The relationship between resistance rate, age, and sex of patients and germ serotype was investigated. RESULTS Isolates were mainly from alveolar lavage (29.3%), expectoration (22.9%), or sputum (15%). Resistance to amoxicillin (61.4%), amoxicillin/clavulanic acid (47.4%), and cefotaxime (39.3%) was high and correlated with the presence of β-lactamase and/or modifications of the ftsI gene encoding penicillin-binding protein 3. Resistance to sulfamethoxazole/trimethoprim (33.2%) was more moderate. There were no significant differences according to serotype, age, or gender. CONCLUSIONS The benefit/risk balance of first choice use of amoxicillin and even of amoxicillin/clavulanic acid in AOM is questionable in view of the significant resistance to H. influenzae. The use of sulfamethoxazole/trimethoprim could be an alternative but may still need further evaluation.
Collapse
Affiliation(s)
- Anas Taha
- Université Paris-Est Créteil, Department of General Practice, Créteil, Frace; Maison de Santé Universitaire de Sucy-en-Brie, Sucy-en-Brie, France.
| | - Florence Adeline
- Université Paris-Est Créteil, Department of General Practice, Créteil, Frace
| | | | | |
Collapse
|
10
|
Antibiotic adverse effects in pediatric acute rhinosinusitis: Systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2022; 156:111064. [PMID: 35231746 DOI: 10.1016/j.ijporl.2022.111064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/12/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric acute bacterial rhinosinusitis (ABRS) is often treated with oral antibiotics, with limited insight into adverse effects (AEs) across drug classes. In this systematic review and meta-analysis, we characterize AE incidence associated with oral antibiotics in these patients. METHODOLOGY/PRINCIPAL We searched PubMed and Embase for English-language articles published from 1985 to September 2020 reporting AEs of oral antibiotic therapy for ABRS patients aged 0-18 years. Six-hundred and sixty-six articles underwent title and abstract screening, identifying 154 articles for full-length review. RESULTS Eleven articles were included, most of which reported individual and aggregate AE incidences. Amoxicillin/clavulanate, amoxicillin, cephalosporin/carbacephem, and placebo groups were identified. Random-effects meta-analysis of prospective groups identified appreciable incidences of diarrhea and abdominal pain, and low incidence of rash, for amoxicillin-clavulanate and amoxicillin. All antibiotics as well as placebo were associated with non-zero overall AE incidence. Children receiving antibiotics were about twice as likely to incur any AE during treatment in placebo-controlled studies, though this association was not significant. High heterogeneity limited most point estimates, with risk of bias, typically in outcomes measurement, detected in most studies. CONCLUSIONS Reporting of AEs associated with oral antibiotic use in pediatric ABRS is limited in current literature. Adverse effects are non-negligible, but may not significantly exceed placebo.
Collapse
|
11
|
Bradley M, Bacharouch A, Hart-Johnson T, Burrows HL, Blackwood RA. Adopting otitis media practice guidelines increases adherence within a large primary care network. J Paediatr Child Health 2021; 57:1054-1059. [PMID: 33592672 DOI: 10.1111/jpc.15389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/03/2020] [Accepted: 01/30/2021] [Indexed: 01/09/2023]
Abstract
AIM Unnecessary antibiotic prescriptions to treat otitis media (OM) contribute to adverse drug reactions, increased cost and antibiotic resistance. Clinical care guidelines can help promote consistent treatment of conditions such as OM. This study evaluates adherence before and after implementation of an institutional guideline for the diagnosis and treatment of paediatric OM. METHODS A retrospective chart review was performed to collect encounter information for paediatric patients seen within a primary care clinic network and diagnosed with OM before and after full implementation of a clinical care guideline. Patient cohorts from 2013 and 2016 were compared to determine which factors, including age, symptoms and diagnosis, were associated with treatment guideline adherence. RESULTS Comparison of encounters from 2013 (n = 418) to 2016 (n = 635) revealed a significant difference in adherence to the 2013 Michigan Medicine Otitis Media Guideline. Overall adherence increased from 61.2% in 2013 to 70.6% in 2016 (χ2 = 9.85, P < 0.0017). Antibiotic use for acute OM decreased from 99.7% in 2013 to 96.7% in 2016 (χ2 = 10.04, P = 0.0015). Antibiotic prescriptions for OM with effusion decreased significantly from 42.9% in 2013 to 17.4% in 2016 (χ2 = 11.93, P < 0.0006). CONCLUSION Implementation of an institutional OM clinical practice guideline contributed to a significant increase in overall treatment adherence of OM for paediatric patients between the 2013 and 2016 cohorts. The number of antibiotic prescriptions for paediatric patients diagnosed with acute OM or OM with effusion significantly decreased from 2013 to 2016.
Collapse
Affiliation(s)
- Mikaela Bradley
- University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan, United States
| | - Ali Bacharouch
- University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Tamera Hart-Johnson
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan, United States
| | - Heather L Burrows
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - R Alexander Blackwood
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan, United States.,Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| |
Collapse
|
12
|
Kashani RG, Młyńczak MC, Zarabanda D, Solis-Pazmino P, Huland DM, Ahmad IN, Singh SP, Valdez TA. Shortwave infrared otoscopy for diagnosis of middle ear effusions: a machine-learning-based approach. Sci Rep 2021; 11:12509. [PMID: 34131163 PMCID: PMC8206083 DOI: 10.1038/s41598-021-91736-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023] Open
Abstract
Otitis media, a common disease marked by the presence of fluid within the middle ear space, imparts a significant global health and economic burden. Identifying an effusion through the tympanic membrane is critical to diagnostic success but remains challenging due to the inherent limitations of visible light otoscopy and user interpretation. Here we describe a powerful diagnostic approach to otitis media utilizing advancements in otoscopy and machine learning. We developed an otoscope that visualizes middle ear structures and fluid in the shortwave infrared region, holding several advantages over traditional approaches. Images were captured in vivo and then processed by a novel machine learning based algorithm. The model predicts the presence of effusions with greater accuracy than current techniques, offering specificity and sensitivity over 90%. This platform has the potential to reduce costs and resources associated with otitis media, especially as improvements are made in shortwave imaging and machine learning.
Collapse
Affiliation(s)
- Rustin G. Kashani
- grid.168010.e0000000419368956Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304 USA
| | - Marcel C. Młyńczak
- grid.1035.70000000099214842Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, Warsaw, Poland
| | - David Zarabanda
- grid.168010.e0000000419368956Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304 USA
| | - Paola Solis-Pazmino
- grid.168010.e0000000419368956Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304 USA
| | - David M. Huland
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, Palo Alto, CA USA
| | - Iram N. Ahmad
- grid.168010.e0000000419368956Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304 USA ,grid.414123.10000 0004 0450 875XLucile Packard Children’s Hospital, Palo Alto, CA USA
| | - Surya P. Singh
- grid.495560.b0000 0004 6003 8393Department of Biosciences and Bioengineering, Indian Institute of Technology Dharwad, Dharwad, Karnataka India
| | - Tulio A. Valdez
- grid.168010.e0000000419368956Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304 USA ,grid.414123.10000 0004 0450 875XLucile Packard Children’s Hospital, Palo Alto, CA USA
| |
Collapse
|
13
|
Sanner JRF, Jain K, Williams J, Smyth AR, Hurley MN. Antibiotics for chronic pulmonary infection in children with a neurodisability (neurodevelopmental disorder). Hippokratia 2020. [DOI: 10.1002/14651858.cd013813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Juliane RF Sanner
- Department of Family Health; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Kamini Jain
- Leicester Children’s Hospital, University Hospitals of Leicester NHS Trust; Leicester UK
| | - Jane Williams
- Department of Family Health; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Alan R Smyth
- Division of Child Health, Obstetrics & Gynaecology; School of Medicine, University of Nottingham; Nottingham UK
| | - Matthew N Hurley
- Paediatric Respiratory Medicine; Nottingham University Hospitals NHS Trust; Nottingham UK
| |
Collapse
|