scholarly journals 51 Overuse of ceftriaxone in children with otitis media: experience at a Canadian tertiary care hospital

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e21-e21
Author(s):  
Mila Arnautovich ◽  
Ann-Christine Godard ◽  
Jean-Francois Turcotte
Keyword(s):  
Otitis Media ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Tertiary Care ◽  
Penicillin Allergy ◽  
White Blood Count ◽  
Oral Drugs ◽  
Broad Spectrum Antibiotics ◽  
Amoxicillin Clavulanate ◽  
History Of

Abstract Background Acute otitis media (AOM) is extremely common. In fact, most children experience at least one ear infection before starting school. It is also recognized as the most frequent reason to administer antibiotics in children. However, many advocate for limited use of antibiotics in healthy children over 6 months of age using a watchful waiting approach. This applies even more for broad-spectrum antibiotics in the context of antibiotic stewardship. The Canadian Paediatric Society (CPS) recommends using parenteral ceftriaxone only when oral drugs are not tolerated or amoxicillin-clavulanate fails. Objectives This primary aim of this study was to describe the use of ceftriaxone in the treatment of children with AOM. Secondary aims were to assess length of therapy and complications as well as determine if the use of ceftriaxone met the criteria of refractory AOM suggested by the CPS. Design/Methods We performed a retrospective observational cohort study of children aged between the ages of 6 months and 5 years with a diagnosis of AOM at a single tertiary care center. All children were seen between March 2017 and February 2019 in a pediatric outpatient medical day unit and received at least one dose of ceftriaxone. Chart review was performed and multiples variables were included in the analysis. Patients with insufficient chart data or with a congenital ear anomaly were excluded. Results A total of 276 patients were included. Patients were aged 17.5 ± 9 months and a majority were boys (N=160). Most patients were fully immunized (N=252). A history of penicillin allergy was reported for 59 patients. Previous AOM was common (N=205) while tympanostomy tubes were rare (N=12). With regards to the diagnosis of AOM, a majority (N=153) had bilateral AOM. Diagnosis of AOM was based on inflammation (N=204), bulging tympanic membrane (N=158) or middle ear effusion (N=118). Fourteen patients had a tympanic perforation. Almost all patients were febrile (N=266). One patient had a positive blood culture (streptococcus pneumoniae) and one had a mastoiditis. Among those who underwent bloodwork (N=212), white blood count was 15.2 ± 6.7 x 109. With regards to antibiotics, most patients (N=218) were initially given oral antibiotics, with amoxicillin given as a first line therapy for 99 patients. A minority of patients received amoxicillin-clavulanate prior to receiving ceftriaxone (N=105). Reasons for the use of ceftriaxone included intolerance to oral drugs (N=18), failure of (or recent exposure to) amoxicillin-clavulanate (N=89) and a history of penicillin allergy (N=50). Most patients were treated with a course of three days with only 51 patients receiving one or two doses. Conclusion In our cohort, the use of ceftriaxone was not limited to nonresponsive AOM. In fact, a minority of patients received ceftriaxone in the setting of intolerance to oral drugs or failure of amoxicillin-clavulanate. This goes against current CPS recommendations and suggests an overuse of broad-spectrum antibiotics. Obviously, this needs to be addressed in the context of antibiotic stewardship.

Pattern of acquisition of hospital-associated pathogens in the ICU of an academic tertiary care hospital

2022 ◽  
Author(s):  
Shazia Damji ◽  
Jerrold Perrott ◽  
Salomeh Shajari ◽  
Jennifer Grant ◽  
Titus Wong ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Median Time ◽  
Broad Spectrum ◽  
Health Authority ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Primary Objective ◽  
Solid Organ ◽  
Care Hospital ◽  
Broad Spectrum Antibiotics

BACKGROUND: Among hospitalized patients, a 48-hour window from time of hospitalization defines nosocomial infections and guides empiric antibiotic selection. This time frame may lead to overuse of broad-spectrum antibiotics. Our primary objective was to determine the earliest and median time since hospital admission to acquire antibiotic-resistant pathogens among patients admitted to the intensive care unit (ICU) of an academic, tertiary care hospital. METHODS: Retrospective chart review was conducted for adult patients admitted to the ICU from home or another hospital within the same health authority in 2018, to identify the time to acquisition of hospital-associated pathogens: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, extended-spectrum beta-lactamase (ESBL)–producing Enterobacterales, non-ESBL ceftriaxone-resistant Enterobacterales, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Patients transferred from hospitals outside the health authority, admitted to ICU after 14 days of hospitalization, who were solid organ or bone marrow transplant recipients, or who were otherwise immunocompromised were excluded. RESULTS: In 2018, 1,343 patients were admitted to this ICU; 820 met the inclusion criteria. Of these, 121 (14.76%) acquired a hospital-associated pathogen in the ICU. The probability of isolating a hospital-associated pathogen by 48 hours of hospital admission was 3%. The earliest time to isolate any of these pathogens was 29 hours, and the median was 9 days (interquartile range [IQR] 3.8–15.6 days). CONCLUSIONS: Most patients (85.3%) in this ICU never acquired a hospital-associated pathogen. The median time to acquire a hospital-associated pathogen among the remaining patients suggests that initiating empiric broad-spectrum antibiotics on the basis of a 48-hour threshold may be premature.

scholarly journals Microbiology of Chronic Suppurative Otitis Media: An update from a Tertiary Care Hospital in Bangladesh

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Mst. Romena Khatun ◽  
Kh. Md. Faisal Alam ◽  
Mahmuda Naznin ◽  
Md. Abdus Salam
Keyword(s):  
Otitis Media ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Chronic Suppurative Otitis Media ◽  
Care Hospital ◽  
Suppurative Otitis Media ◽  
Gram Negative ◽  
Medical College ◽  
Gram Positive Bacteria ◽  
Amoxicillin Clavulanate

Objectives: Chronic suppurative otitis media is a major cause of acquired hearing impairment, especially in children of developing countries. The study sought to explore the bacteriological profile and their antimicrobial susceptibility among patients of chronic suppurative otitis media from a tertiary care hospital in Bangladesh. Methods: A cross sectional microbiological study was conducted at the Department of Microbiology, Rajshahi Medical College, Bangladesh from January to December 2019. Aural swabs were collected aseptically from clinically suspected patients irrespective of age and gender attending the ear, nose and throat outpatient department of Rajshahi Medical College Hospital. Aerobic bacterial culture was done and isolates were identified through standard bacteriological identification scheme. Antimicrobial susceptibility testing of isolates was done by modified Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Results: Of 96 swabs, culture yielded a total of 73 bacterial isolates from 68(70.8%) culture-positive plates including 63 (65.6%) unimicrobial and 5 (5.2%) polymicrobial (mixed growth of a pair of bacteria) growths. Frequency distribution revealed, 40(55%) gram-negative and 33(45%) gram-positive bacteria with Staphylococcus aureus was the leading isolate (37%) followed by Pseudomonas aeruginosa (31.5%), Escherichia coli (13.7%), coagulase-negative Staphylococcus (8.2%), Klebsiella pneumoniae (5.5%) and Proteus spp. (4.1%). Gram-positive bacteria were found to be highly susceptible (100%) to Linezolid and Vancomycin followed by Imipenem (83 to 96.3%), while moderate to high resistance (44 to 67%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime, Amoxicillin/Clavulanate and Clindamycin. For gram-negative bacteria, susceptibility ranged from 67 to 100% to Imipenem, 67 to 96% to Piperacillin/Tazobactam and 67 to 83% to Gentamicin, while moderate to high resistance (50 to 75%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime and Amoxicillin/Clavulanate. Conclusion: Moderate to high level of multidrug-resistance especially to 3rd generation cephalosporins, Ciprofloxacin and Amoxicillin/Clavulanate is an alarming situation. It warns reinforcement of judicious antibiotic prescription and introduction of antibiotic stewardship program in the tertiary care hospitals. doi: https://doi.org/10.12669/pjms.37.3.3942 How to cite this:Khatun MR, Alam KMF, Naznin M, Salam MA. Microbiology of Chronic Suppurative Otitis Media: An update from a Tertiary Care Hospital in Bangladesh. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3942 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S308-S308 ◽  
Author(s):  
Adam Pettigrew ◽  
Ripal Jariwala ◽  
Kristen Zeitler ◽  
Jose Montero ◽  
Sandra Gompf ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clostridium Difficile ◽  
Bloodstream Infection ◽  
Broad Spectrum ◽  
Case Series ◽  
Prior History ◽  
Broad Spectrum Antibiotics ◽  
History Of ◽  
Polymicrobial Bacteremia ◽  
Hospital Acquired

Abstract Background While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined. Methods We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned. Results Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia. Conclusion CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB. Disclosures All authors: No reported disclosures.

scholarly journals A Decision Tree Using Patient Characteristics to Predict Resistance to Commonly Used Broad-Spectrum Antibiotics in Children With Gram-Negative Bloodstream Infections

2019 ◽  
Vol 9 (2) ◽  
pp. 142-149 ◽  
Author(s):  
Anna C Sick-Samuels ◽  
Katherine E Goodman ◽  
Glenn Rapsinski ◽  
Elizabeth Colantouni ◽  
Aaron M Milstone ◽  
...  
Keyword(s):  
High Risk ◽  
Decision Tree ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Intestinal Transplantation ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative ◽  
Broad Spectrum Antibiotics

Abstract Background As rates of multidrug-resistant gram-negative infections rise, it is critical to recognize children at high risk of bloodstream infections with organisms resistant to commonly used empiric broad-spectrum antibiotics. The objective of the current study was to develop a user-friendly clinical decision aid to predict the risk of resistance to commonly prescribed broad-spectrum empiric antibiotics for children with gram-negative bloodstream infections. Methods This was a longitudinal retrospective cohort study of children with gram-negative bacteria cared for at a tertiary care pediatric hospital from June 2009 to June 2015. The primary outcome was a bloodstream infection due to bacteria resistant to broad-spectrum antibiotics (ie, cefepime, piperacillin-tazobactam, meropenem, or imipenem-cilastatin). Recursive partitioning was used to develop the decision tree. Results Of 689 episodes of gram-negative bloodstream infections included, 31% were resistant to broad-spectrum antibiotics. The decision tree stratified patients into high- or low-risk groups based on prior carbapenem treatment, a previous culture with a broad-spectrum antibiotic resistant gram-negative organism in the preceding 6 months, intestinal transplantation, age ≥3 years, and ≥7 prior episodes of gram-negative bloodstream infections. The sensitivity for classifying high-risk patients was 46%, and the specificity was 91%. Conclusion A decision tree offers a novel approach to individualize patients’ risk of gram-negative bloodstream infections resistant to broad-spectrum antibiotics, distinguishing children who may warrant even broader antibiotic therapy (eg, combination therapy, newer β-lactam agents) from those for whom standard empiric antibiotic therapy is appropriate. The constructed tree needs to be validated more widely before incorporation into clinical practice.

Treatment of Patients with a History of Penicillin Allergy in a Large Tertiary-Care Academic Hospital

2013 ◽  
Vol 1 (3) ◽  
pp. 252-257 ◽  
Author(s):  
Matthieu Picard ◽  
Philippe Bégin ◽  
Hugues Bouchard ◽  
Jonathan Cloutier ◽  
Jonathan Lacombe-Barrios ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Penicillin Allergy ◽  
Academic Hospital ◽  
Large Tertiary Care ◽  
History Of

scholarly journals High-Dose Azithromycin versus High-Dose Amoxicillin-Clavulanate for Treatment of Children with Recurrent or Persistent Acute Otitis Media

2003 ◽  
Vol 47 (10) ◽  
pp. 3179-3186 ◽  
Author(s):  
Antonio Arrieta ◽  
Adriano Arguedas ◽  
Pilar Fernandez ◽  
Stan L. Block ◽  
Paz Emperanza ◽  
...  
Keyword(s):  
Otitis Media ◽  
Clinical Success ◽  
Acute Otitis Media ◽  
High Dose ◽  
Success Rates ◽  
Double Blind ◽  
Amoxicillin Clavulanate ◽  
Risk Patients ◽  
History Of ◽  
Intent To Treat

ABSTRACT Infants and young children, especially those in day care, are at risk for recurrent or persistent acute otitis media (AOM). There are no data on oral alternatives to high-dose amoxicillin-clavulanate for treating AOM in these high-risk patients. In this double-blind, double-dummy multicenter clinical trial, we compared a novel, high-dose azithromycin regimen with high-dose amoxicillin-clavulanate for treatment of children with recurrent or persistent AOM. Three hundred four children were randomized; 300 received either high-dose azithromycin (20 mg/kg of body weight once a day for 3 days) or high-dose amoxicillin-clavulanate (90 mg/kg divided twice a day for 10 days). Tympanocentesis was performed at baseline; clinical response was assessed at day 12 to 16 and day 28 to 32. Two-thirds of patients were aged ≤2 years. A history of recurrent, persistent, or recurrent plus persistent AOM was noted in 67, 18, and 14% of patients, respectively. Pathogens were isolated from 163 of 296 intent-to-treat patients (55%). At day 12 to 16, clinical success rates for azithromycin and amoxicillin-clavulanate were comparable for all patients (86 versus 84%, respectively) and for children aged ≤2 years (85 versus 79%, respectively). At day 28 to 32, clinical success rates for azithromycin were superior to those for amoxicillin-clavulanate for all patients (72 versus 61%, respectively; P = 0.047) and for those aged ≤2 years (68 versus 51%, respectively; P = 0.017). Per-pathogen clinical efficacy against Streptococcus pneumoniae and Haemophilus influenzae was comparable between the two regimens. The rates of treatment-related adverse events for azithromycin and amoxicillin-clavulanate were 32 and 42%, respectively (P = 0.095). Corresponding compliance rates were 99 and 93%, respectively (P = 0.018). These data demonstrate the efficacy and safety of high-dose azithromycin for treating recurrent or persistent AOM.

scholarly journals Veterinarians’ Perception, Knowledge and Practices of Antibiotic Stewardship in Enugu State Southeast, Nigeria

2017 ◽  
Vol 9 (3) ◽  
pp. 321-331 ◽  
Author(s):  
Madubuike Umunna ANYANWU ◽  
Oluwatosin Ajoke KOLADE
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Southeastern Nigeria ◽  
Significance Level ◽  
Broad Spectrum Antibiotics ◽  
Enugu State ◽  
Antibiotic Stewardship Abs

A cross-sectional survey utilizing structured questionnaires was used to study the veterinarians’ perception, knowledge and practices of antibiotic stewardship (ABS) in Enugu State, Southeastern Nigeria. Data obtained were analyzed using chi-square on SPSS (Version 15.0) at a significance level of P < 0.05 to determine possible associations between variables and perceptions/knowledge about ABS. Out of 280 respondents, 41 (17.1%) had heard about ABS. Minority of the respondents perceived/knew that using antibiotics only when necessary (6.4%, 18), administering antibiotics at the appropriate dose (6.4%, 18) and administering antibiotics for appropriate duration in every case (4.3%, 12) were among the principles of ABS. The study also showed that age, gender, qualification, years of practice and locations did not exert any influence (P > 0.05) on the awareness of respondents about ABS. More than one-third of the respondents wrongly perceived that increasing the use of broad-spectrum antibiotics (35.4%, 99) is one of the goals of ABS, whereas the minority of the respondents rightly perceived/knew that minimizing toxicity and other adverse effects (16.8%, 47) and reducing antibiotic resistance (ABR) (43.2%, 121) are also goals of ABS. Only 21.4% (60) had overall knowledge of ABS. Prescribing antibiotics without seeing/examining the patient, prescribing antibiotics for any case suspected to be infectious, prescribing broad-spectrum antibiotics despite availability of narrow-spectrum antibiotics, prescribing different classes/types of antibiotics concurrently to ensure therapeutic efficacy, prescribing overdose of antibiotics to ensure efficacy and non-consultation of the  veterinary formulary/other resources when in doubt during prescription, are some of inappropriate/untoward ABS practices/behaviors/attitudes amongst the respondents. No significant association (P > 0.05) was found between practices of ABS and age, gender, qualification, years of practice and location. In conclusion, the veterinarians’ awareness/perception and practices of ABS is abysmally poor in the study area, thus education of Nigerian veterinarians about ABS and the teaching of the principles and practices of ABS during veterinary schools are recommended. 

scholarly journals Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257993
Author(s):  
Sara Rossin ◽  
Elisa Barbieri ◽  
Anna Cantarutti ◽  
Francesco Martinolli ◽  
Carlo Giaquinto ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Clinical Pathways ◽  
Community Acquired Pneumonia ◽  
Broad Spectrum Antibiotics ◽  
Outpatient Group ◽  
Before And After ◽  
Tract Infections ◽  
The Impact

Introduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broad-spectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians’ awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with community-acquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1–5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients’ group’s broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group’s antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update.

scholarly journals Inhaled Antibiotics for the Prevention of Respiratory Tract Infections in Children With a Tracheostomy

2021 ◽  
Vol 9 ◽  
Author(s):  
Camille Jutras ◽  
Julie Autmizguine ◽  
Maryline Chomton ◽  
Christopher Marquis ◽  
The Thanh-Diem Nguyen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Respiratory Tract ◽  
Broad Spectrum ◽  
Respiratory Tract Infections ◽  
Tertiary Care ◽  
Case Series ◽  
Broad Spectrum Antibiotics ◽  
Case Series Study ◽  
Inhaled Antibiotics ◽  
Tract Infections

Objective: To describe the use of prophylactic inhaled antibiotics in children with a tracheostomy and assess if its use is associated with a reduction in exposition to broad-spectrum antibiotics and a lower risk of acquired respiratory tract infections.Methods: A case series study was performed in a tertiary care university affiliated hospital. All consecutive children (&lt;18 years old) with a tracheostomy, hospitalized between January 2004 and November 2016, and treated with prophylactic inhaled antibiotics were identified. We analyzed the 3 month- period before and after initiation of prophylactic inhaled antibiotics and described exposure to broad spectrum antibiotics, the number of respiratory tract infections and the associated adverse events.Results: Six children (median age: 11 months, range: 8–100) were included. One received colimycin, 3 received tobramycin and 2 were treated with both antibiotics in alternance. The median duration of treatment was 74 days (22–173) with one patient still being treated at the end of the study. Patients were exposed to systemic antibiotics for 18 days (2–49) in the 3 months preceding the treatment vs. 2 days (0–15) in the 3 months following the treatment initiation (p = 0.115). The number of respiratory tract infections went from median of 2 (0–3) to 1 (0–1) during the same periods (p = 0.07). Adverse events most commonly reported were cough (n = 2) and increased respiratory secretions post-inhalation (n = 4). Only one new bacterial resistance was observed.Conclusions: This series of consecutive cases underlines the need for future studies evaluating the potential benefit of prophylactic inhaled antibiotics in children with a tracheostomy.

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