Evidence Update for Parents: Narrow- versus Broad-Spectrum Antibiotics for Common Infections in Children

Throat Infection ◽

Research Findings ◽

New Research ◽

Choosing an Antibiotic for Your Child's Ear, Nose, or Throat Infection. New research findings can help you and your child’s clinician figure out the best option for treating your child’s infection. When bacteria cause your child’s ear, nose, or throat infection, your clinician will suggest one of two kinds of antibiotics. One kind is narrow-spectrum antibiotics. These medicines fight just the bacteria that are most likely causing your child’s ear, nose, or throat infection. Examples are amoxicillin or Amoxil®. The other kind is broad-spectrum antibiotics. These medicines fight many kinds of bacteria at the same time. Examples are azithromycin or Z-Pak®.

Evidence Update for Clinicians: Narrow- versus Broad-Spectrum Antibiotics for Common Infections in Children

10.25302/eu5.2018.10 ◽

2018 ◽

Author(s):

Keyword(s):

Respiratory Tract ◽

Broad Spectrum ◽

Respiratory Tract Infections ◽

Acute Otitis Media ◽

Streptococcal Pharyngitis ◽

Upper Respiratory Tract ◽

Group A ◽

Tract Infections ◽

Comparing Narrow- vs. Broad-Spectrum Antibiotics for Common Infections in Children. The choice of antibiotic to treat acute bacterial upper respiratory tract infections in children can affect both symptom resolution and the risk of side effects such as diarrhea and vomiting. The findings of a PCORI-funded study published in JAMA can help clinicians treating children for acute respiratory tract infections (ARTIs)—including acute otitis media, Group A streptococcal pharyngitis, and acute sinusitis—make decisions with parents about the medicine that is best for the child. The study, led by Jeffrey Gerber, a pediatrician and researcher at the Children’s Hospital of Philadelphia, included 30,086 children ages 6 months to 12 years taking narrow- and broad-spectrum antibiotics to treat ARTIs.

Narrow-spectrum antibiotics are as effective as broad-spectrum antibiotics in the treatment of community-acquired pneumonia

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2015-308815 ◽

2015 ◽

Vol 100 (4) ◽

pp. 223-223 ◽

Cited By ~ 3

Author(s):

Anna Selby ◽

Katrina Pettit ◽

Nick Brown

Keyword(s):

Broad Spectrum ◽

Community Acquired Pneumonia ◽

Narrow Spectrum ◽

Broad Spectrum Antibiotics

Broad-spectrum antibiotics gave no clinical benefit and more adverse effects than narrow-spectrum antibiotics in treating acute respiratory tract infections in US children

BMJ evidence-based medicine ◽

10.1136/bmjebm-2018-110938 ◽

2018 ◽

Vol 24 (3) ◽

pp. 119-120 ◽

Cited By ~ 5

Author(s):

Morten Lindbaek

Keyword(s):

Adverse Effects ◽

Respiratory Tract ◽

Broad Spectrum ◽

Clinical Benefit ◽

Respiratory Tract Infections ◽

Acute Respiratory Tract Infections ◽

Narrow Spectrum ◽

Tract Infections ◽

Us Children

Introducing new point-of-care tests for common infections in publicly funded clinics in South Africa: a qualitative study with primary care clinicians

BMJ Open ◽

10.1136/bmjopen-2019-029260 ◽

2019 ◽

Vol 9 (11) ◽

pp. e029260 ◽

Cited By ~ 3

Author(s):

Oliver van Hecke ◽

Chris Butler ◽

Marc Mendelson ◽

Sarah Tonkin-Crine

Keyword(s):

South Africa ◽

Primary Care ◽

Broad Spectrum ◽

Point Of Care ◽

Antibiotic Prescribing ◽

Western Cape ◽

Publicly Funded ◽

Primary Care Clinicians ◽

Broad-spectrum antibiotics are routinely prescribed empirically in the resource-poor settings for suspected acute common infections, which drive antimicrobial resistance. Point-of-care testing (POCT) might increase the appropriateness of decisions about whether and which antibiotic to prescribe, but implementation will be most effective if clinician’s perspectives are taken into account.ObjectivesTo explore the perceptions of South African primary care clinicians working in publicly funded clinics about: making antibiotic prescribing decisions for two common infection syndromes (acute cough, urinary tract infection); their experiences of existing POCTs; their perceptions of the barriers and opportunities for introducing (hypothetical) new POCTs.Design, method, participants, settingQualitative semistructured interviews with 23 primary care clinicians (nurses and doctors) at publicly funded clinics in the Western Cape Metro district, South Africa. Data were analysed using thematic analysis.ResultsClinicians reported that their antibiotic prescribing decisions were influenced by their clinical assessment, patient comorbidities, social factors (eg, access to care) and perceived patient expectations. Their experiences with currently available POCTs were largely positive, and they were optimistic about the potential for new POCTs to: support evidence-based prescribing decisions that might reduce unnecessary antibiotic prescriptions; reduce the need for further investigations; support effective communication with patients, especially when antibiotics were unlikely to be of benefit. Resources and workflow disruption were seen as the main barriers to uptake into routine care.ConclusionsClinicians working in publicly funded clinics in the Western Cape Metro of South Africa saw POCTs as potentially useful for positively addressing both clinical and social drivers of the overprescribing of broad-spectrum antibiotics, but were concerned about the resource implications and disruption of existing patient workflows.

Supramolecular antibiotics: a strategy for conversion of broad-spectrum to narrow-spectrum antibiotics for Staphylococcus aureus

Nanoscale ◽

10.1039/d0nr04886k ◽

2020 ◽

Vol 12 (40) ◽

pp. 20693-20698

Author(s):

Thameez M. Koyasseril-Yehiya ◽

Alam García-Heredia ◽

Francesca Anson ◽

Poornima Rangadurai ◽

M. Sloan Siegrist ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Broad Spectrum ◽

Bacterial Population ◽

Narrow Spectrum ◽

Broad Spectrum Antibiotics

Supramolecular antibiotics: a reactive supramolecular disassembly approach ensures the narrow delivery of broad-spectrum antibiotics to selectively target pathogenic bacterial population.

Evaluation of the Quality of Antibiotic Prescribing in Primary Care: A Multicenter Longitudinal Study From Shenzhen, China

Frontiers in Pharmacology ◽

10.3389/fphar.2020.617260 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yanhong Gong ◽

Hui Li ◽

Heping Yang ◽

Kun Tan ◽

Wei Liu ◽

...

Keyword(s):

Primary Care ◽

Broad Spectrum ◽

Substantial Reduction ◽

Guideline Recommendation ◽

Antibiotic Prescribing ◽

Oral Antibiotics ◽

First Line ◽

Background: Currently, there is no comprehensive evaluation of the quality of antibiotic prescribing in China’s primary care facilities based on longitudinal data.Methods: We randomly selected 11 community health centers in Shenzhen, China, and collected all outpatient prescriptions of these centers from 2010 to 2015. To evaluate the quality of antibiotic prescribing, we used six quality indicators for analysis, including number of antibiotics per 100 consultations, ratio between broad-spectrum and narrow-spectrum antibiotics (B/N ratio), percentage of first-line antibiotics recommended by guidelines, percentage of oral antibiotics with a duration exceeding the guideline recommendation, and new pediatric-specific indicators such as percentage of antibiotics with amoxicillin (A index) and ratio between amoxicillin and broad-spectrum antibiotics (A/B ratio).Results: During the study period, 571,362 outpatient consultations resulted in antibiotic prescriptions, which contained 706,411 antibiotics. The overall number of antibiotics per 100 consultations decreased significantly from 93.50 in 2010 to 19.98 in 2015 (p = 0.004), but the B/N ratio showed an upward trend over time (p = 0.009). In different populations and different common infections, the number of antibiotics used decreased to varying degrees, while the B/N ratio increased to varying degrees, with the most obvious change in children <5 years. The percentage of first-line antibiotics for common infections was not high, ranging from 3.45 to 44.25% during 2014–2015. The percentage of oral antibiotics with an exceeded duration ranged from 0.70 to 19.39%. Moreover, the A index and A/B ratio in children remained low for a long time, which was 0.76% and 0.01 in 2015.Conclusion: A review of antibiotic prescribing in Shenzhen, China, showed a substantial reduction in antibiotic use in primary care. However, problems such as widespread use of broad-spectrum antibiotics, insufficient use of first-line antibiotics and low use of amoxicillin were prevalent. Improving and optimizing the quality of antibiotic prescribing, particularly in children prescriptions, will be the focus of future antibiotic stewardship in China.

1446. The Impact of Enterobacteriaceae Isolate Breakpoints on Prescriber Treatment Choices for Discordant Pattern Urinary Tract Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1310 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S528-S528

Author(s):

Philip Lee ◽

Yi Guo ◽

Wendy Szymczak ◽

Vijaya L Soma ◽

Priya Nori

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Broad Spectrum ◽

White Blood Cells ◽

Narrow Spectrum ◽

Group A ◽

Group B ◽

Tract Infections ◽

The Impact

Abstract Background Our institution revealed Enterobacteriaceae with discordant cefazolin (CEF)-resistant / ampicillin-sulbactam (SAM) susceptible patterns (CRASS-P). This discordance could be from the multiple MIC cephalosporin breakpoint adjustments from CLSI. SAM has higher resistance for gram-negative bacteria compared with cephalosporins such as CEF which is confirmed by our antibiogram. We sought to understand if narrow-spectrum antibiotic choices for CRASS-P urinary tract infections (UTIs) led to clinical cure (CC). Methods We conducted a retrospective review from January 2018 to February 2019 of all CRASS-P Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae isolates from urine cultures. Patients with any symptom related to a UTI, urinalysis with >10 white blood cells/high-powered field, urine culture with >10,000 colony-forming units/mL, and receipt of an antibiotic were included. CC was defined as symptom resolution within 48 hours with no return to care within 28 days of the positive urinary culture. “Group A” included patients prescribed narrow-spectrum antibiotics such SAM, CEF, or an oral cephalosporin (OC) vs. broad-spectrum antibiotics such as ceftriaxone, quinolones or sulfa-medications (“Group B”). Results There were 960/1356 (70.8%) CRASS-P urinary isolates and 244 patients met inclusion criteria. Of 244 patients, 72 were in Group A and 172 were in Group B. There was no difference in the diversity of the 3 uropathogens, P = 0.34 (Table 1). Median age was 69±20.3 and 67.5±23.9 years for Group A and Group B, respectively, P = 0.23. Females accounted for 73.6% and 77.9% in Group A and B, respectively, P = 0.51. Overall, patients reached CC in 98.6% (71/72) of Group A patients, compared with 92.4% (159/172) of Group B patients, P = 0.07. Antibiotics used in treatment are outlined in Figure 1. UTI was associated with bacteremia for 2 patients in Group A and 4 patients in Group B (P = 0.84). Both patients in Group A reached CC and used AMC for treatment. However, 1 out of 4 patients did not achieve CC in Group B. Conclusion The use of SAM or OC can spare the broad-spectrum antibiotics use for CRASS-P UTIs as there was no statistical difference in CC between the two groups. The use of SAM with CRASS-P bacteremia secondary to UTI is possible; however, future studies are needed. Disclosures All authors: No reported disclosures.