Short-Course antimicrobial therapy for upper respiratory tract infections

OBJECTIVE: This review examines the issues surrounding short-course antimicrobial therapy of group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis, acute (suppurative) otitis media, and acute sinusitis. BACKGROUND: Accumulating evidence suggests that short-course (ie, < or = 5 days) antimicrobial therapy may have equivalent or superior efficacy compared with traditional longer (10- to 14-day) therapies. RESULTS: In GABHS tonsillopharyngitis, short-course therapy with 6 days of amoxicillin, 4 or 5 days of various cephalosporins, and 5 days of azithromycin (10 mg/kg once daily on all 5 days in pediatric patients) are all reasonable alternatives to traditional 10-day penicillin therapy. In uncomplicated acute (suppurative) otitis media, single-dose intramuscular ceftriaxone or 3- to 5-day short-course oral antimicrobial therapy should be effective in > or = 80% of patients. However, more research is needed in children aged <2 years, since short-course therapy may not be successful in most patients in this population. In sinusitis, most short-course therapy data have involved acute maxillary disease in adult patients. Preliminary results are encouraging, but more study is needed, especially in children. CONCLUSIONS: Cost-containment in antimicrobial therapy should include consideration of short-course therapy in the management of upper respiratory tract infections.     

National trends in appropriate antibiotics use among pediatric inpatients with uncomplicated lower respiratory tract infections in Japan

BackgroundJapan was ranked as the worst country of 36 high-income countries in terms of oral antibiotic consumptions for children. Knowing the patterns and variations of antibiotic use for pediatric inpatients with uncomplicated respiratory infections is an important step to promote judicious antibiotic use.MethodsDischarge records were extracted for children aged between 3 months and 15 years with acute lower respiratory tract infections for the fiscal years 2010–2014 using a national inpatient database in Japan. We investigated the trends in antibiotic use using mixed effect regression models and ascertained variations and clustering of the practice patterns across different hospitals using unsupervised machine learning methodology.ResultsA total of 280,298 children were included in the study. Total and broad-spectrum antibiotic use, except for fluoroquinolone, showed decreasing trends from 2010 to 2014. Additionally, the proportions of patients who received no antibiotics or only penicillin increased from 17.1% to 9.9% in 2010 to 24.5% and 13.7% in 2014, respectively. Cluster analysis showed that only one-quarter of hospitals used no antibiotics for 28.8% of children and only penicillin for 53.7% of children. In the remaining clusters of hospitals, the piperacillin, 3rd generation cephalosporins, and penicillin beta-lactamase inhibitors were used for 68.5%, 68.5%, and 69.6% of the patients who received antibiotics.ConclusionsSlightly increasing trends in narrow-spectrum antibiotics were observed. However, the treatment strategy in only one-quarter of hospitals was consistent with the current recommendations. Hospital level interventions to promote and monitor antibiotic use could be helpful to improve antibiotic use for pediatric inpatients.     

不同小儿麻醉气道管理方案在围术期上呼吸道感染儿童中的对比

目的：探讨不同小儿麻醉气道管理方案在围术期上呼吸道感染儿童中应用价值。方法选取2012年6月至2013年10月该院收治的200例合并有轻度或中度上呼吸道感染且须行全身麻醉开腹手术患儿,随机分为喉罩组和气管插管组,每组各100例。气管插管组进行气管插管。喉罩组置入合适的ProSeal喉罩,对不同时点的平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PetCO2）以及心率等指标进行监测。观察并记录两组患儿在麻醉复苏期出现的并发症以及术后24 h的呼吸道感染症状等。结果 T2与 T4时点喉罩组心率分别为（113．48±10．21）、（115．24±11．36）次/分,明显低于气管插管组的（123．84±14．22）、（123．96±14．85）次/分,差异均有统计学意义（P＜0．05）;T0～T1、T3、T5时点两组患儿的心率比较,差异均无统计学意义（P＞0．05）;各时点两组患儿在MAP、SpO2以及PetCO2等方面相比较,差异均无统计学意义（P＞0．05）;麻醉复苏期喉罩组患儿低氧血症、术后烦躁、咽喉痛以及喉痉挛等并发症发生率均明显低于气管插管组;喉罩组患儿术后24 h的鼻塞、咳嗽、痰鸣音、啰音、喘鸣以及咳痰等上呼吸道感染症状的发生率明显低于气管插管组,差异均有统计学意义（P＜0．05）。结论相比于气管插管,采用喉罩对合并有上呼吸道感染须行开腹手术的患儿进行麻醉气道管理,具有操作相对简单、刺激性小、患儿耐受性好、能够保持心率平稳、麻醉复苏期不良事件的发生率低、术后上呼吸道感染症状轻等方面优点,值得临床推广应用。     

Echinacea purpurea for prevention of upper respiratory tract infections in children

OBJECTIVE: The aim of this study was to determine whether Echinacea purpurea given to children for the treatment of acute upper respiratory tract infection (URI) was effective in reducing the risk of subsequent URI. DESIGN: This was a secondary analysis of data from a randomized, double-blind, placebo-controlled trial of Echinacea for the treatment of URI in children. SETTING: The study was conducted as a joint project between the Puget Sound Pediatric Research Network (Seattle, WA) and Bastyr University (Kenmore, WA). PARTICIPANTS: A total of 524 children ages 2 to 11 years were enrolled in the study. INTERVENTION: Children were monitored for URIs over a 4-month observation period during the fall/winters of 2000-2001 and 2001-2002. At entry the children were randomized to receive Echinacea or placebo to treat acute URIs during the observation period. MAIN OUTCOME MEASURES: The occurrence of a second URI and the number of days between the end of the first URI and the start of the second URI was ascertained. Survival and Cox regression analyses were used to determine whether children who took Echinacea for their URIs were less likely to develop subsequent URIs. RESULTS: Among the 401 children with at least one URI treated with study medication, 69.2% of those receiving placebo developed a second URI versus 55.8% of those who received Echinacea. Use of Echinacea was associated with a 28% decreased risk of subsequent URI (p = 0.01, 95% confidence interval 8%-44% decreased risk). CONCLUSIONS: Echinacea purpurea may be effective in reducing the occurrence of subsequent URIs in children. However this finding needs to be replicated in a URI prevention trial.     

Implementing AORN Recommended Practices for Medication Safety

Medication errors in the perioperative setting can result in patient morbidity and mortality. The AORN “Recommended practices for medication safety” provide guidance to perioperative nurses in developing, implementing, and evaluating safe medication use practices. These practices include recognizing risk points in the medication use process, collaborating with pharmacy staff members, conducting preoperative assessments and postoperative evaluations (eg, medication reconciliation), and handling hazardous medications and pharmaceutical waste. Strategies for successful implementation of the recommended practices include promoting a basic understanding of the nurse's role in the medication use process and developing a medication management plan as well as policies and procedures that support medication safety and activities to measure compliance with safe practices.     

The evaluation of upper respiratory tract infection symptoms to show the significance of developing a quality-of-life evaluation instrument for upper respiratory tract infections to assess respiratory disorder-related disability

In a majority of clinical trials in upper respiratory tract infections (URTIs), it is now standard to include a measure of health-related quality of life (HRQOL) as a key outcome, and numerous clinicians are now adding QOL to routine clinical assessments. Because of this, the design of a disease-specific instrument for URTIs that has strong measurement properties and is more sensitive to minute changes is of great value in having an appropriate perception of what value patients put on their QOL and how changes in these values correlate with positive or negative progress in health. This is an attempt to show the significance and effects of URTIs on the affected patient and the potential genesis in the construction of a HRQOL evaluative tool named QOLAURTI, which, if eventually tested for interpretability with positive results, will measure fluctuations in a patient's QOL score that will correlate with minute but significant, moderate, or huge improvement or decline in a patient's QOL and also help in treating illness of URTI origin by classifying severity of illness. Relevant articles retrieved through PubMed and MEDLINE were cited to describe the impact of URTIs. Current published and available references outlining ways to construct an effective evaluative instrument that is based on the specific disease state and its impact on affected patients are employed to help construct a QOL questionnaire that could be effective in measuring the QOL of an affected patient. The construction of a potentially effective evaluative tool was achieved and is included here. However, since this tool was not tested due to inadequate numbers of test subjects and facilities required, its reliability, validity, and interpretability cannot be determined as of yet. Patients with URTIs are usually troubled by nasal symptoms and other symptoms including fatigue and headache. It can be inferred that suffering from these symptoms concomitantly can cause quite severe impairments of normal daily human protocol including physical, occupational, and social functioning and can also cause emotional distress. Because of the importance of the potential impact of these symptoms on affected individuals, a closer look into how these symptoms affect the HRQOL of an individual is important. The main goal in treating patients with URTIs is to make sure that all individual patient problems are recognized so that they can be treated properly. To achieve this, it is important to measure QOL. Research has shown that generic health-status questionnaires are able to compare burden of illness across different medical conditions but that they are not usually responsive enough to small but clinically essential changes in patients' QOL. Because of this, it is important to have a disease-specific instrument for URTIs that can measure the QOL of the affected individual. The main importance in measuring the QOL of the affected individual would be in assessing the potential effectiveness of drug therapies and treatment protocols used in treating URTIs.     

Emergency Department Medication History Taking: Current Inefficiency and Potential for a Self-Administered Form

Background

Emergency Departments (EDs) struggle with obtaining accurate medication information from patients.

Objective

Our aim was to estimate the proportion of urban ED patients who are able to complete a self-administered medication form and record patient observations of the medication information process.

Methods

In this cross-sectional study, we consecutively sampled ED patients during various shifts between 8 am and 10 pm. We created a one-page medication questionnaire that included a list of 49 common medications, categorized by general indications. We asked patients to circle any medications they took and write the names of those not on the form in a dedicated area on the bottom of the page. After their visit, we asked patients to recall which providers had asked them about their medications.

Results

Research staff approached 354 patients; median age was 45 years (interquartile range 29–53 years). Two hundred and forty-nine (70%) completed a form, 61 (17%) were too ill, 19 (5%) could not read it, and 25 (7%) refused to participate. Excluding refusals, 249 of 329 (76%; 95% confidence interval 70–80%) were able to complete the form. Of 209 patients recalling their visit, 180 (86%) indicated that multiple providers took a history, including 103 in which every provider did so, and 9 (4%) indicated that no provider took a medication history.

Conclusions

The process of ED medication information transfer often involves redundant efforts by the health care team. More than 70% of patients presenting for Emergency care were able to complete a self-administered medication information form.     

Community-acquired upper respiratory tract infections and the role of third-generation oral cephalosporins

Evaluation of: Thussu A, Chattopadhyay A, Sawhney IS, Khandelwal N. Albendazole therapy for single small enhancing CT lesion (SSECTL) in brain in epilepsy. J. Neurol. Neurosurg. Psychiatry DOI: jnnp.2007.128058v1 (2007) (Epub ahead of print).

Neurocysticercosis is a major cause of neurologic disease worldwide. In India and other developing countries, single small enhancing computed tomographic lesions representing solitary cysticercus granuloma are a common cause of new-onset seizures. The interesting feature of these solitary enhancing lesions is their spontaneous disappearance within a few weeks. The modalities of treatment that have been evaluated in these patients include antituberculous drugs, albendazole and corticosteroids. In several series, patients received only antiepileptic therapy to control seizures. There is consensus among experts that these patients require antiepileptic therapy. Some experts think that antiepileptic drugs may be withdrawn safely after the lesion has resolved. In several studies, treatment with albendazole has been tried but, because of conflicting results, its role in management of solitary cysticercus granuloma is uncertain. The present study by Thussu et al. also could not establish the exact role of albendazole in the management of solitary cysticercus granuloma. The authors observed that albendazole treatment led to early resolution of the solitary cysticercus granuloma. However, significantly better radiological resolution of lesions did not result in improved seizure-related prognosis. To resolve the issue of effectiveness of albendazole, properly conducted multicentric randomized control studies are needed.     

537例儿科患者下呼吸道感染病原菌分布与耐药性特征分析

目的：探讨儿科患者下呼吸道感染的病原菌分布与耐药性特征,以期指导临床合理使用抗菌药物。方法：回顾性分析537例儿科患者呼吸道感染的病原菌分布和耐药性特征。结果：537株分离的病原菌中,革兰阴性杆菌占79．3％（426／537）,以肺炎克雷伯菌（KP）、大肠埃希菌（EC）和铜绿假单胞菌（PA）为主;革兰阳性球菌占19．7％（106／537）,以金黄色葡萄球菌和肺炎链球菌为主。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对氨苄西林、头孢唑林和头孢呋辛的耐药率均较高,而对阿米卡星和亚胺培南敏感。金黄色葡萄球菌对青霉素、头孢唑啉和红霉素的耐药率分别为96．6％（57／59）,44．1％（26／59）和42．4％（25／59）,但对万古霉素和利奈唑胺的敏感率为100％。肺炎链球菌对青霉素敏感,耐药率仅为4．2％（1／24）;对万古霉素敏感率为100％;对红霉素和四环素耐药率较高,分别为79．2％（19／24）和62．5％（15／24）。结论：定期监测病原菌的分布和耐药性变化,对儿科下呼吸道感染的诊断和治疗具有重要意义。     

福建医科大学附属泉州第一医院儿科患者碳青霉烯类抗生素临床合理用药分析

目的评价福建医科大学附属泉州第一医院儿科住院患者碳青霉烯类抗生素的临床合理应用情况。方法回顾性分析2018年儿科96例患者碳青霉烯类抗生素的用药情况。结果共点评96例患者,男68例,女28例,中位年龄(四分位距)1.00(4.95)岁,中位体重(四分位距)9.00(17.33)kg;微生物送检94例,送检率为97.92%;细菌培养阳性32例,阳性率34.04%,分离菌株主要来源于静脉血和痰液,占70.00%;碳青霉烯类药物的中位用药天数(四分位距)为8.00(8.75)d。综合评价100分85例,90分3例,80分2例,0分6例。扣分项目包括适应证不符合,用法用量及配伍不当,使用抗菌药物前无相应的病原学检查,以及治疗过程中缺乏对疗效进行评估的动态实验室检查等。结论该院儿科住院患者碳青霉烯类抗生素应用基本合理,但临床科室需严格控制碳青霉烯类在感染患儿中的应用,强调病原学诊断,尽早实施目标性治疗。还应积极开展合理用药专项点评和临床培训,规范碳青霉烯类抗生素的应用。