scholarly journals Antibiotic exposure and ‘response failure’ for subsequent respiratory tract infections: an observational cohort study of UK preschool children in primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e638-e646 ◽  
Author(s):  
Oliver van Hecke ◽  
Alice Fuller ◽  
Clare Bankhead ◽  
Sara Jenkins-Jones ◽  
Nick Francis ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Preschool Children ◽  
Respiratory Tract ◽  
Treatment Failure ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Antibiotic Exposure ◽  
Tract Infections ◽  
Antibiotic Courses

BackgroundChildhood antibiotic exposure has important clinically relevant implications. These include disruption to the microbiome, antibiotic resistance, and clinical workload manifesting as treatment ‘failure’.AimTo examine the relationship between the number of antibiotic courses prescribed to preschool children for acute respiratory tract infections (RTI), in the preceding year, and subsequent RTIs that failed to respond to antibiotic treatment (‘response failures’).Design and settingA cohort study using UK primary care data from the Clinical Practice Research Datalink, 2009 to 2016.MethodChildren aged 12 to 60 months (1 to 5 years) who were prescribed an antibiotic for an acute RTI (upper and lower RTI or otitis media) were included. One random index antibiotic course for RTI per child was selected. Exposure was the number of antibiotic prescriptions for acute RTI up to 12 months before the index antibiotic prescription. The outcome was ‘response failure’ up to 14 days after index antibiotic prescription, defined as: subsequent antibiotic prescription; referral; hospital admission; death; or emergency department attendance within 3 days. The authors used logistic regression models to estimate the odds between antibiotic exposure and response failure.ResultsOut of 114 329 children who were prescribed an antibiotic course for acute RTI, children who received ≥2 antibiotic courses for acute RTIs in the preceding year had greater odds of response failure; one antibiotic course: adjusted odds ratio (OR) 1.03 (95% confidence interval [CI] = 0.88 to 1.21), P = 0.67, n = 230 children; ≥2 antibiotic courses: adjusted OR 1.32 (CI = 1.04 to 1.66), P = 0.02, n = 97.ConclusionChildhood antibiotic exposure for acute RTI may be a good predictor for subsequent response failure (but not necessarily because of antibiotic treatment failure). Further research is needed to improve understanding of the mechanisms underlying response failure.

scholarly journals Primary care management of respiratory tract infections in Dutch preschool children

2006 ◽  
Vol 24 (4) ◽  
pp. 231-236 ◽  
Author(s):  
Angelique G. S. C. Jansen ◽  
Elisabeth A. M. Sanders ◽  
Anne G. M. Schilder ◽  
Arno W. Hoes ◽  
Vanya F. G. M. de Jong ◽  
...  
Keyword(s):  
Primary Care ◽  
Preschool Children ◽  
Respiratory Tract ◽  
Care Management ◽  
Respiratory Tract Infections ◽  
Tract Infections ◽  
Primary Care Management

scholarly journals Early childhood respiratory morbidity and antibiotic use in ex-preterm infants: a primary care population-based cohort study

2020 ◽  
Vol 56 (1) ◽  
pp. 2000202
Author(s):  
Shin Tan ◽  
Lisa Szatkowski ◽  
William Moreton ◽  
Linda Fiaschi ◽  
Tricia McKeever ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Childhood ◽  
Cohort Study ◽  
Respiratory Tract ◽  
Preterm Infants ◽  
Respiratory Tract Infections ◽  
Hospital Admissions ◽  
Antibiotic Use ◽  
Respiratory Morbidity ◽  
Tract Infections

BackgroundGlobally, bronchopulmonary dysplasia (BPD) continues to increase in preterm infants. Recent studies exploring subsequent early childhood respiratory morbidity have been small or focused on hospital admissions.AimsTo examine early childhood rates of primary care consultations for respiratory tract infections (RTI), lower respiratory tract infections (LRTI), wheeze and antibiotic prescriptions in ex-preterm and term children. A secondary aim was to examine differences between preterm infants discharged home with or without oxygen.MethodsRetrospective cohort study using linked electronic primary care and hospital databases of children born between 1997 and 2014. We included 253 277 eligible children, with 1666 born preterm at <32 weeks' gestation, followed-up from primary care registration to age 5 years. Adjusted incidence rate ratios (aIRRs) were calculated.ResultsEx-preterm infants had higher rates of morbidity across all respiratory outcomes. After adjusting for confounders, aIRRs for RTI (1.37, 95% CI 1.33–1.42), LRTI (2.79, 95% CI 2.59–3.01), wheeze (3.05, 95% CI 2.64–3.52) and antibiotic prescriptions (1.49, 95% CI 1.44–1.55) were higher for ex-preterm infants. Ex-preterm infants discharged home on oxygen had significantly greater morbidity across all respiratory diagnoses and antibiotic prescriptions compared to those without home oxygen. The highest rates of respiratory morbidity were observed in children from the most deprived socioeconomic groups.ConclusionEx-preterm infants, particularly those with BPD requiring home oxygen, have significant respiratory morbidity and antibiotic prescriptions in early childhood. With the increasing prevalence of BPD, further research should focus on strategies to reduce the burden of respiratory morbidity in these high-risk infants after hospital discharge.

scholarly journals Antibiotic Use and Appropriateness in the Treatment of Acute Respiratory Tract Infections in Tunisian Primary Care and Emergency Departments (Barometer Study): a Multicenter Cross-sectional Observational Clinical Study

2021 ◽  
Author(s):  
Khaoula Bel Haj Ali ◽  
Adel Sekma ◽  
Selma Messous ◽  
Imen Trabelsi ◽  
Jalel Ben Youssef ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Study ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Acute Bronchitis ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
History Of ◽  
Tract Infections

Abstract BackgroundLittle is known about the pattern and appropriateness of antibiotic prescriptions in patients with acute respiratory tract infections (ARTIs).Objective Describe the antibiotics used to treat ARTIs in Tunisian primary care offices and emergency departments (EDs), and assess the appropriateness of their use.MethodsIt was a multicenter cross-sectional observational clinical study conducted at 63 primary care offices and 6 EDS during a period of 8 months. Appropriateness of antibiotic prescription was evaluated by trained physicians using the medication appropriateness index (MAI). The MAI ratings generated a weighted score of 0 to 18 with higher scores indicating low appropriateness. The study was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The study was approved by the Ethics committee of Monastir Medical Faculty.ResultsFrom the 12880 patients screened we included 9886 patients. The mean age was 47.4, and 55.4% were men. The most frequent diagnosis of ARTI was were acute bronchitis (45.3%), COPD exacerbation (16.3%), tonsillitis (14.6%), rhinopharyngitis (12.2%) and sinusitis (11.5%). The most prescribed classes of antibiotics were penicillins (58.3%), fluoroquinolones (17.6%), and macrolides (16.9%). Antibiotic therapy was inappropriate in 75.5% of patients of whom 65.2% had bronchitis. 65% of patients had one or more antibiotic prescribing inappropriateness criteria as assessed by the MAI. The most frequently rated criteria were with expensiveness (75.8%) and indication (40%). Amoxicillin-clavulanic acid and levofloxacin were the most inappropriately prescribed antibiotics. History of cardiac ischemia ([OR] 3.66; 95% [CI] 2.17-10.26; p<0.001), asthma ([OR] 3.29, 95% [CI] 1.77-6.13; p<0.001), diabetes ([OR] 2.09, 95% [CI] 1.54-2.97; p=0.003), history of COPD ([OR] 1.75, 95% [CI] 1.43-2.15; p<0.001) and age >65 years (Odds Ratio [OR] 1.35, 95% confidence interval [CI] 1.16-1.58; p<0.001) were associated with a higher likelihood of inappropriate prescribing.ConclusionOur findings indicate a high inappropriate use of antibiotics in ARTIs treated in in primary care and EDs. This was mostly related to antibiotic prescription in acute bronchitis and overuse of expensive broad spectrum antibiotics. Future interventions to improve antibiotic prescribing in primary care and EDs is needed.Trial registrationthe trial is registered at Clinicaltrials.gov registry (NCT04482231)

scholarly journals Delayed antibiotic prescription in upper respiratory tract infections: a new trend?

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Carolina Castanheira ◽  
Isabel Andrade ◽  
Rui Cruz
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Rapid Tests ◽  
Upper Respiratory ◽  
Tract Infections ◽  
Delayed Antibiotic Prescription

Abstract Background Upper respiratory tract infections (URTI) are one of the main reasons for consultation in primary care. Approximately 60% of all antibiotic prescriptions aim at the treatment of URTI, even without a laboratory-based diagnosis. Delayed antibiotic prescription in primary care has shown to reduce antibiotic consumption, without increasing risk of complications, yet is not widely used. Rapid tests to confirm the etiology of URTI are available at pharmacies, but not purchased routinely. In this context, the aim of this study is to assess the knowledge of rapid tests for the diagnosis of URTI, and the awareness of strategies to decrease antibiotic use. Methods A team of experts in the field developed a questionnaire specifically for the purpose of this study. The Pharmacy graduate students of ESTESC-Coimbra Health School (Portugal) answered the questionnaire online. Results Over 90% of the respondents with a URTI stated that the general practitioner prescribed the antibiotic without a lab test. When given the option, 58% are willing to pay up to 50 Euros for a rapid test, yet are not familiar with any brand. Although the respondents aren’t familiarized with the concept, when asked, the majority (87%) are more likely to choose a delayed than an immediate prescription. Conclusions Pharmacy graduates are willing to support the use of delayed prescription, to give time for the lab confirmation of the diagnosis. A broader dissemination of the clinical evidence supporting the use of rapid tests and of delayed prescription is necessary to help managing URTI.

scholarly journals Daycare attendance and respiratory tract infections: a prospective birth cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e014635 ◽  
Author(s):  
Linnea Schuez-Havupalo ◽  
Laura Toivonen ◽  
Sinikka Karppinen ◽  
Anne Kaljonen ◽  
Ville Peltola
Keyword(s):  
Cohort Study ◽  
Respiratory Tract ◽  
Birth Cohort ◽  
Day Care ◽  
Repeated Measures ◽  
Respiratory Tract Infections ◽  
Birth Cohort Study ◽  
Tract Infections ◽  
Prospective Birth Cohort ◽  
Prospective Birth Cohort Study

ObjectiveWe explored the burden of respiratory tract infections (RTIs) in young children with regard to day-care initiation.DesignLongitudinal prospective birth cohort study.Setting and methodsWe recruited 1827 children for follow-up until the age of 24 months collecting diary data on RTIs and daycare. Children with continuous daycare type and complete data were divided into groups of centre-based daycare (n=299), family day care (FDC) (n=245) and home care (n=350). Using repeated measures variance analyses, we analysed days per month with symptoms of respiratory tract infection, antibiotic treatments and parental absence from work for a period of 6 months prior to and 9 months after the start of daycare.ResultsWe documented a significant effect of time and type of daycare, as well as a significant interaction between them for all outcome measures. There was a rise in mean days with symptoms from 3.79 (95% CI 3.04 to 4.53) during the month preceding centre-based daycare to 10.57 (95% CI 9.35 to 11.79) at 2 months after the start of centre-based daycare, with a subsequent decrease within the following 9 months. Similar patterns with a rise and decline were observed in the use of antibiotics and parental absences. The start of FDC had weaker effects. Our findings were not changed when taking into account confounding factors.ConclusionsOur study shows the rapid increase in respiratory infections after start of daycare and a relatively fast decline in the course of time with continued daycare. It is important to support families around the beginning of daycare.

scholarly journals Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Milena Bergmann ◽  
Jörg Haasenritter ◽  
Dominik Beidatsch ◽  
Sonja Schwarm ◽  
Kaja Hörner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Respiratory Tract ◽  
Chronic Cough ◽  
Respiratory Tract Infections ◽  
Meta Analysis ◽  
Current Guideline ◽  
Acute Cough ◽  
Reason For Encounter ◽  
Tract Infections

Abstract Background Cough is a relevant reason for encounter in primary care. For evidence-based decision making, general practitioners need setting-specific knowledge about prevalences, pre-test probabilities, and prognosis. Accordingly, we performed a systematic review of symptom-evaluating studies evaluating cough as reason for encounter in primary care. Methods We conducted a search in MEDLINE and EMBASE. Eligibility criteria and methodological quality were assessed independently by two reviewers. We extracted data on prevalence, aetiologies and prognosis, and estimated the variation across studies. If justifiable in terms of heterogeneity, we performed a meta-analysis. Results We identified 21 eligible studies on prevalence, 12 on aetiology, and four on prognosis. Prevalence/incidence estimates were 3.8–4.2%/12.5% (Western primary care) and 10.3–13.8%/6.3–6.5% in Africa, Asia and South America. In Western countries the underlying diagnoses for acute cough or cough of all durations were respiratory tract infections (73–91.9%), influenza (6–15.2%), asthma (3.2–15%), laryngitis/tracheitis (3.6–9%), pneumonia (4.0–4.2%), COPD (0.5–3.3%), heart failure (0.3%), and suspected malignancy (0.2–1.8%). Median time for recovery was 9 to 11 days. Complete recovery was reported by 40.2- 67% of patients after two weeks, and by 79% after four weeks. About 21.1–35% of patients re-consulted; 0–1.3% of acute cough patients were hospitalized, none died. Evidence is missing concerning subacute and chronic cough. Conclusion Prevalences and incidences of cough are high and show regional variation. Acute cough, mainly caused by respiratory tract infections, is usually self-limiting (supporting a “wait-and-see” strategy). We have no setting-specific evidence to support current guideline recommendations concerning subacute or chronic cough in Western primary care. Our study presents epidemiological data under non non-pandemic conditions. It will be interesting to compare these data to future research results of the post-pandemic era.

Effects of procalcitonin testing on antibiotic use and clinical outcomes in patients with upper respiratory tract infections. An individual patient data meta-analysis

2017 ◽  
Vol 56 (1) ◽  
Author(s):  
Jonas Odermatt ◽  
Natalie Friedli ◽  
Alexander Kutz ◽  
Matthias Briel ◽  
Heiner C. Bucher ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Respiratory Tract Infections ◽  
Meta Analysis ◽  
Antibiotic Exposure ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Restricted Activity ◽  
Tract Infections

AbstractBackground:Several trials found procalcitonin (PCT) helpful for guiding antibiotic treatment in patients with lower respiratory tract infections and sepsis. We aimed to perform an individual patient data meta-analysis on the effects of PCT guided antibiotic therapy in upper respiratory tract infections (URTI).Methods:A comprehensive search of the literature was conducted using PubMed (MEDLINE) and Cochrane Library to identify relevant studies published until September 2016. We reanalysed individual data of adult URTI patients with a clinical diagnosis of URTI. Data of two trials were used based on PRISMA-IPD guidelines. Safety outcomes were (1) treatment failure defined as death, hospitalization, ARI-specific complications, recurrent or worsening infection at 28 days follow-up; and (2) restricted activity within a 14-day follow-up. Secondary endpoints were initiation of antibiotic therapy, and total days of antibiotic exposure.Results:In total, 644 patients with a follow up of 28 days had a final diagnosis of URTI and were thus included in this analysis. There was no difference in treatment failure (33.1% vs. 34.0%, OR 1.0, 95% CI 0.7–1.4; p=0.896) and days with restricted activity between groups (8.0 vs. 8.0 days, regression coefficient 0.2 (95% CI –0.4 to 0.9), p=0.465). However, PCT guided antibiotic therapy resulted in lower antibiotic prescription (17.8% vs. 51.0%, OR 0.2, 95% CI 0.1–0.3; p<0.001) and in a 2.4 day (95% CI –2.9 to –1.9; p<0.001) shorter antibiotic exposure compared to control patients.Conclusions:PCT guided antibiotic therapy in the primary care setting was associated with reduced antibiotic exposure in URTI patients without compromising outcomes.

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