scholarly journals 1324Clinical Registry for Acute Respiratory Infections in Children in Western Australia

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Mejbah Bhuiyan ◽  
Rebecca Pavlos ◽  
Sharon O'Brien ◽  
Meredith Borland ◽  
Sarah Doyle ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Clinical Care ◽  
Antibiotic Use ◽  
Chronic Illnesses ◽  
Acute Respiratory Infections ◽  
Clinical Registry ◽  
Emergency Presentation ◽  
Antimicrobial Interventions

Abstract Background Acute respiratory infections (ARIs) are the leading cause for emergency presentation and a major driver for antibiotic use in children. In 2020, we established an ARI clinical registry to: evaluate clinical care for ARI to inform clinical guidelines; and as a platform for clinical trials assessing antimicrobial interventions. Methods Any child <16 years presenting to Perth Children’s Hospital Emergency Department (ED) with cough, fever, sore throat and/or difficulty breathing was eligible for enrolment. Using an automated survey sent to parents’ mobile phones, each enrolled child was followed weekly until 28 days or disease recovery (whichever occurred first). Data collected included clinical symptoms, antibiotic prescription, adherence, and duration to return to regular activity (recovery). Results From Feb 2020-April 2021, 448 participants were enrolled (84% <5 years). Fever and cough were the most frequently reported symptoms. Of 448, 274 (61%) ARI cases completed all surveys until recovered. The median recovery length was 9 days (IQR:6-12). The recovery days were longer, although not statistically significant (p > 0.05), in: children who received antibiotics versus those who did not (9.5 days vs. 8); children <5 years versus those over (9 days vs. 7); and children with chronic illnesses versus those without (9 days vs. 8). Conclusions Most children presenting to ED with ARI recover within 10 days. The length of recovery does not vary significantly by age, chronic illnesses, or antibiotic usage. Key messages Registry data provides baseline data to inform clinical trials assessing the role and duration of antibiotics for ARI.

scholarly journals The Acute Respiratory Infection Consortium: A Multi-Site, Multi-Disciplinary Clinical Research Network in the Department of Defense

2019 ◽  
Vol 184 (Supplement_2) ◽  
pp. 44-50 ◽  
Author(s):  
Christian Coles ◽  
Eugene V Millar ◽  
Timothy Burgess ◽  
Martin G Ottolini
Keyword(s):  
Clinical Trials ◽  
Influenza Vaccine ◽  
Clinical Research ◽  
Military Personnel ◽  
Pandemic Influenza ◽  
Respiratory Infections ◽  
Respiratory Viruses ◽  
Research Area ◽  
Acute Respiratory Infections ◽  
Live Attenuated Influenza Vaccine

Abstract Introduction Acute respiratory infections (ARI) result in substantial annual morbidity among military personnel and decrease operational readiness. Herein, we summarize the research efforts of the Infectious Disease Clinical Research Program (IDCRP) related to ARIs. Methods The ARI Research Area of the IDCRP was established in response to the 2009 emergence of pandemic influenza A/H1N1. That year, IDCRP investigators deployed the ARI Consortium Natural History Study (ARIC NHS), a multi-centered, longitudinal observational study to assess etiology, epidemiology, and clinical characteristics of influenza-like illness (ILI) and severe acute respiratory infections (SARI) in the U.S. military. The success of this initial effort spurred implementation of several new initiatives. These include the FluPlasma trial, designed to evaluate the efficacy of hyperimmune anti-influenza plasma for the treatment of severe influenza; the self-administered live-attenuated influenza vaccine (SNIF) trial, which assessed the immunogenicity and acceptance of a self-administered live-attenuated influenza vaccine in military personnel; the Study to Address Threats of ARI in Congregate Military Populations (ATARI), a prospective study of ILI transmission, etiology and epidemiology in recruits; and the Flu Breath Test (FBT) study, a preliminary study of exhaled volatile organic compounds (VOC) in influenza patients. In addition, the InFLUenza Patient-Reported Outcome (FLU-PRO) survey, a daily diary to measure influenza symptoms during clinical trials, was developed. Lastly, the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) study, a two-year randomized trial designed to compare the effectiveness of the three types of licensed vaccines, launched in Fall 2018. Results The on-going ARIC NHS has enrolled over 2000 ILI and SARI cases since its inception, providing data on burden and clinical manifestations of ARI in military personnel and their families. The FluPlasma 2 trial concluded subject enrollment in 2018. Preliminary results from ATARI study show a high frequency of respiratory viruses circulating during the first two weeks of recruit training. Based on assessment of FLU-PRO responses, which were found to be reliable and reproducible, the survey may be a useful tool in clinical trials and epidemiological studies. The Flu Breath Study will complete enrollment in 2019. Findings from PAIVED are intended to provide evidence needed for assessing influenza vaccination policy in the military. Conclusions The ARI burden in the armed services remains significant every year and the threat is dynamic given emergent and evolving threats, such as influenzas. With strong successes to date, future initiatives of the ARI Research Area will focus on interventional studies, ARI transmission dynamics in congregate military settings, and determinants of risk of pandemic influenza and other emergent respiratory viruses.

scholarly journals 1992. Initial Procalcitonin Level and Antibiotic Practice Patterns Among Patients with Acute Respiratory Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S668-S668
Author(s):  
Jessica K Costales ◽  
Jim H Nomura ◽  
Wen-Ling Joanie. Chung ◽  
Kristen Ironside ◽  
John J Sim ◽  
...  
Keyword(s):  
Health System ◽  
Real World ◽  
Practice Patterns ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
Primary Diagnosis ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Prescribing Practices

Abstract Background The utility of procalcitonin (PCT)-guided algorithms to decrease antibiotic use has been extensively studied in clinical trials. The guidance that PCT provides as it translates into real-world practice is unclear. This study aims to describe real-world antibiotic prescribing practices in relation to PCT in patients admitted to our US-based health system with acute respiratory infections. Methods Retrospective cohort study of 1,606 adults admitted within our US health system from January 1, 2016 to December 31, 2018 with a primary diagnosis of acute upper or lower respiratory infection with at least one PCT measurement. Antibiotic practice patterns were evaluated using pharmacy analytic information and antibiotic status to note antibiotics given prior to and 36 hours after PCT result. Analysis of discordance with initial PCT level was defined as continuing or starting antibiotics after a low PCT level (PCT ≤0.25 μg/L) and withholding or discontinuing antibiotics after a high PCT level (PCT > 0.25 μg/L). Results Antibiotic prescription patterns after the result of initial PCT level are summarized in Table 1. Only 242 patients (15%) had more than one PCT-level checked. Overall, antibiotic discordance with initial PCT result was 45%; mostly attributed to continuing or starting antibiotics despite a low PCT level (77%). (Figure 1) There were 496 patients who were initially started and continued on antibiotics despite a low PCT result. Of this subgroup, only one patient had a serial PCT measured, and 12 were admitted for Chronic Obstructive Pulmonary Disease (COPD) exacerbation and continued on azithromycin/doxycycline after result of the low PCT. Conclusion Utilization of antibiotics went against well-studied PCT cutoffs 45% of the time, primarily driven by antibiotic use at low PCT levels. Only a small number were continued on azithromycin/doxycycline for anti-inflammatory effect in COPD exacerbations, indicating that most patients received antibiotics for presumed bacterial infection despite the high negative predictive value of PCT. This study illustrates PCT use in real-world practice did not significantly alter prescribing practices, potentially from lack of confidence or knowledge in interpreting PCT results and lack of serial measurements to aid in decision-making. Disclosures All authors: No reported disclosures.

Delayed prescriptions for reducing antibiotic use in acute respiratory infections

2006 ◽  
Author(s):  
B Arroll ◽  
R Elley ◽  
F Goodyear-Smith ◽  
T Kenealy ◽  
N Kerse
Keyword(s):  
Respiratory Infections ◽  
Antibiotic Use ◽  
Acute Respiratory Infections

Delayed prescriptions for reducing antibiotic use in acute respiratory infections

2004 ◽  
Author(s):  
B Arroll ◽  
R Elley ◽  
F Goodyear-Smith ◽  
T Kenealy ◽  
N Kerse
Keyword(s):  
Respiratory Infections ◽  
Antibiotic Use ◽  
Acute Respiratory Infections
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