A study on evaluation of prescription pattern of drugs in upper respiratory tract infections in children at a tertiary care hospital

Background: Acute respiratory tract infections (ARTIs) are a major burden to child health in developing countries like India. Preschool children have 4–8 episodes of the upper respiratory tract infection (URTI) per year on average, while school-aged children experience 2–6 episodes per year. They are the most prevalent reason for visits to the outpatient section of a hospital and general practice. Aim and Objective: The aim of this study was to evaluate the prescribing patterns in patients aged 1–18 years with URTIs. Materials and Methods: A prospective study conducted in the department of pharmacology at a tertiary health care center. Two hundred and fifty patients with URTI visiting pediatric and ENT department of tertiary health care center during December 2014–June 2015 were studied. Data included detailed history, physical examination, investigations, antimicrobial treatment given, and other treatment given were noted. This data was gathered from the records of Pediatric and ENT department. Statistical tests were used to analyze the data. Results: The most common clinical presentation was fever and cough. The common diagnosis noted in the study were non-specific URTI, tonsillitis, and sinusitis. Antipyretics (99.6%) and antibiotics (52%) were the frequently prescribed drugs among the patients. Amoxicillin-clavulanic acid and cephalosporins were the common antibitoics prescribed. Beta-hemolytic streptococci were the common microbe isolated among the patients tested to know the etiology. Conclusion: Antipyretics (99.6%) and antibiotics (52%) were the frequently prescribed drugs among the patients. Antibiotics were prescribed in most of the non-specific URTI and pharyngitis which is a matter of concern.

Poliarterite nodosa cutânea na infância com gangrena digital e possível associação com o estreptococo beta-hemolítico do grupo a: relato de caso e revisão de literatura / Cutaneous polyarteritis nodosa in children presenting with digital gangrene and possible association with group a beta hemolytic streptococcus infection

A poliarterite nodosa cutânea (PAN cutânea) é uma forma particular de vasculite envolvendo artérias de pequeno e médio calibres. A doença pode ser diferenciada da poliarterite nodosa sistêmica pela sua limitação à pele e ausência de envolvimento visceral. Manifesta-se habitualmente por nódulos subcutâneos, livedo reticular e ulceração cutânea. Artralgia, mialgia, neuropatia e sintomas constitucionais, como febre e mal-estar, podem estar presentes. O diagnóstico é, por vezes, de difícil realização, baseando-se na forte suspeita clínica e no exame histológico da pele. Neste trabalho é descrito um caso de PAN cutânea em uma criança de 9 anos com alteração isquêmica grave da ponta dos dedos e nódulos subcutâneos como manifestações iniciais e a provável associação com o estreptococo beta-hemolítico grupo A (EBHGA). A revisão de literatura revela que PAN cutânea na infância está freqüentemente associada à infecção estreptocócica e que atenção especial deveria ser dada a crianças com menos de 10 anos de idade pelo alto risco relatado de auto-amputações.

Cutaneous polyarteritis nodosa (cutaneous PAN) is a particular form of vasculitis involving small and medium sized arteries. The disease can be differentiated from classic PAN by its limitation to the skin and lack of progression to visceral involvement. Usually it manifests with subcutaneous nodule, livedo reticularis and cutaneous ulceration. Arthralgia, myalgia, neuropathy and constitutional symptoms such as fever and malaise may also be present. Sometimes the diagnosis is difficult, being just based on clinical suspicion and skin histologic exam. In this paper the authors describe the case of cutaneous PAN in a 9 years old child with severe ischemic changes in the fingertips, and subcutaneous nodules as initial signs of cutaneous PAN and probable association with the group A beta hemolytic streptococcus (GABHS). The review of the literature shows that the cutaneous PAN in the childhood may be associated to streptococcal infection and, for this reason, a special care should be given for those under 10 years old due to the high risk of self amputation.

Macrolide Resistance Trends in beta-Hemolytic Streptococci in a Tertiary Korean Hospital

PURPOSE: Erythromycin-resistant beta-hemolytic streptococci (BHS) has recently emerged and quickly spread between and within countries throughout the world. In this study, we evaluate the antimicrobial susceptibility patterns and erythromycin resistance mechanisms of BHS during 2003-2004. MATERIALS AND METHODS: The MICs of seven antimicrobials were determined for 204 clinical isolates of BHS from 2003 to 2004. Resistance mechanisms of erythromycin-resistant BHS were studied by the double disk test as well as by polymerase chain reaction (PCR). RESULTS: Compared with our previous study, resistance among Streptococcus pyogenes isolates to a variety of drugs decreased strikingly: from 25.7% to 4.8% in erythromycin; 15.8% to 0% in clindamycin; and 47.1% to 19.0% in tetracycline. The prevalent phenotypes and genotypes of macrolide-lincosamide-streptograminB (MLSB) resistance in Streptococcus pyogenes isolates have been changed from the constitutive MLSB phenotype carrying erm(B) to the M phenotype with mef(A) gene. In contrast with Streptococcus pyogenes, resistance rates to erythromycin (36.7%), clindamycin (43.1%), and tetracycline (95.4%) in Streptococcus agalactiae isolates did not show decreasing trends. Among the Streptococcus dysgalactiae subsp. equisimilis isolates (Lancefield group C, G), resistance rates to erythromycin, clindamycin, tetracycline and chloramphenicol were observed to be 9.4%, 3.1%, 68.8%, and 9.4%, respectively. CONCLUSION: Continual monitoring of antimicrobial resistance among large-colony-forming BHS is needed to provide the medical community with current data regarding the resistance mechanisms that are most common to their local or regional environments.

Distribution of Beta-Hemolytic Streptococci of Throat Culture of Elementary School Children in Jinju Area, 2004 / 대한임상미생물학회지

BACKGROUND: The carrier study of group A streptococci (GAS), the most common cause of bacterial pharyngitis, is important to understand the epidemiology of GAS in the region. The authors performed throat cultures from the children of four elementary schools in Jinju area to investigate current microbiological characteristics in this area. METHODS: Throat cultures were taken from 2,351 healthy elementary school children (male 1,311 and female 1,040) from October through December, 2004. Two schools are located in rural areas, while the other two schools are in Jinju city. Beta-hemolytic streptococci (BHS) were identified with bacitracin disk (0.04 U) and latex agglutination test (Seroiden Strepto Kit, Eiken). RESULTS: Four-hundred forty-three (18.8%) yielded BHS from 2,351 school children. Serogrouping revealed 84.9% of group A, 5.9% of group C, 4.7% of group B, 3.6% of group G, and 0.9% of non-group A, B, C, G in a decreasing order. Isolation rate of GAS was similar between girls and boys. Children of elementary schools in rural areas showed significantly higher isolation rates (18.6-21.7%) compared to those (12.5-12.7%) in urban areas. CONCLUSION: The isolation rate of BHS was 18.8% in Jinju area, 2004. Group A was 84.9% and group C was next common. Although the isolation rate of GAS was similar by age or sex, it showed a significant difference by the location of the schools.

PANDAS: un modelo autoinmune de trastorno cerebral / PANDAS: an autoimmune model of mental disorder

En 1998, el Instituto Nacional de Salud Mental de los Estados Unidos definió los criterios de diagnóstico para los trastornos neuropsiquiá-tricos asociados a infección por estreptococo beta hemolítico del grupo A (PANDAS). Desde entonces se ha investigado la génesis de la autoinmunidad mediada por este microorganismo y sus impli-caciones clínicas, ya que se ha asociado con el trastorno obsesivo compulsivo, trastorno de la Tourette, corea de Sydenham y con menor evidencia con el trastorno de hiperactividad con déficit de atención, trastorno autista y anorexia nerviosa. La presente es una revisión sobre los aspectos más importantes que se han definido hasta el momento con respecto a la fisiopatología, presentación clínica y manejo de los pacientes del espectro PANDAS, pues son un grupo en el que se podrá cambiar el paradigma de tratamiento en psiquiatría de sintomático a etiológico. [Cadena LP, Toloza CR, Rueda GE. PANDAS: un modelo autoinmune de trastorno cerebral. MedUNAB 2004; 7:106-14]

PANDAS: an autoimmune model of mental disorder. In 1998, the National Institute of Mental Health defined the criteria of diagnosis for the pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Since then there has been investigating the genesis of the autoimmunity caused by this micro-organism and its clinical implications, since it has been associated with the obsessive-compulsive disorder, Tourette's disorder and Sydenham's chorea and with minor evidence it has been related to of hyperactivity disorder with lack of attention, autistic disorder and anorexia nervosa. The present article is a review on the most important aspects that have been defined up to now in regards to the physiopatlogy, clinical presentation and management of the patients with PANDAS spectrum, since they are a group of diseases in which it will be possible to change the paradigm of treatment in Psychiatry, from being a symptomatic disease to an etiological one

Macrolide Resistance in beta-Hemolytic Streptococci: Changes after the Implementation of the Separation of Prescribing and Dispensing of Medications Policy in Korea

This study evaluated the antimicrobial susceptibilities and macrolide resistance mechanisms of beta-hemolytic streptococci (BHS), and an additional objective was to assess the effects of 'the separation of prescribing and dispensing (SPD) of medications' on bacterial resistance rate and distribution of phenotypes and genotypes of erythromycin-resistant BHS by comparing the antimicrobial susceptibility data before (1990- 2000) and after the implementation of SPD at one tertiary care hospital in South Korea. Between the period of January 2001 and December 2002, the minimal inhibitory concentrations of six antimicrobials were determined for 249 clinical isolates of BHS. Resistance mechanisms of erythromycin-resistant (intermediate and resistant) isolates were studied by using the double disk test and PCR. Overall, the resistance rates to tetracycline, erythromycin, and clindamycin were 75.5%, 32.9%, and 32.5%, respectively. Sixty-seven (81.7%) of 82 erythromycin- resistant isolates expressed constitutive resistance to macrolide- lincosamide-streptogramin B antibiotics (a constitutive MLSB phenotype) ; 11 isolates (13.4%) expressed an M phenotype; and four isolates (4.9%) had an inducible MLSB resistance phenotype. erm (A) was found in isolates with constitutive/ inducible MLSB phenotypes, erm (B) with the constitutive/ inducible MLSB phenotype, and mef (A) with the M phenotype. We found that resistance rates to erythromycin and clindamycin among S. agalactiae, S. pyogenes, and group C streptococci isolates were still high after the implementation of the SPD policy in Korea, and that the constitutive MLSB resistance phenotype was dominant among erythromycin- resistant BHS in this Korean hospital.

Distributions of Macrolide-Lincosamide-Streptogramin (MLS) Resistance Types in beta-hemolytic Streptococci / 대한임상미생물학회지

BACKGROUND: Macrolide resistance in beta-hemolytic streptococci has increased during the 1990s, and the proportion of MLS (Macrolide-lincosamide-streptogramin) resistance phenotypes and genotypes of beta-hemolytic streptococci are quite different by geographical variation and study period. The aim of the present study was to determine the distribution of MLS resistance phenotypes and genotypes in beta-hemolytic streptococci isolated from Wonju Christian Hospital. METHODS: The minimal inhibitory concentrations of erythromycin and clindamycin of 426 beta- hemolytic streptococci isolated from clinical specimens between 1990 to 1999 were determined by agar dilution method. MLS resistance phenotypes were determined by double disk diffusion method using erythromycin and clindamycin disk, and genotypes were determined by polymerase chain reaction (PCR). The PCR primers for erm(A), erm(B), erm(C), erm(TR), and mef(A) were used in these study. RESULTS: The proportion of MLS resistance phenotypes of 80 erythromycin-resistant beta-hemolytic streptococci were 60.0% for constitutive phenotype, 23.8% for M phenotype, and 16.2% for inducible phenotype. The proportion of three MLS resistance phenotypes of group A streptococci were nearly equal. About three-fourths of group B streptococci had the constitutive phenotypes, whereas three-fourths (75%) of group G streptococci had the M phenotypes. All MLS resistant strains carried the erm(B) genes in constitutive phenotypes, erm(TR) genes in inducible phenotypes, and mef(A) genes in M phenotypes, respectively. CONCLUSIONS: Mechanisms and phenotype proportions of MLS resistance are different by species in beta-hemolytic streptococci. It is possible that MLS resistance genes have transferred among beta- hemolytic streptococci because the erythromycin resistance genes are the same in beta-hemolytic streptococci.

Serogroup Distribution of Beta-hemolytic Streptococci Isolated from a Tertiary Care Hospital at Wonju Area during the Recent 4 Years (1997~2000) / 감염

BACKGROUND: Beta-hemolytic streptococci (BHS) are frequently isolated pathogens in the clinical microbiology laboratory, and the isolation frequency of each serogroup of BHS are influenced by patient type, nation and region, study period, and investigators. The aim of this study is to investigate the isolation rates and distribution of BHS by serogroup at Wonju area during the recent periods. METHODS: Isolation rates of BHS isolated from 1997 to 2000 at Wonju Christian Hospital were investigated. The distribution of each serogroup of BHS according to the types of clinical specimens was also studied. Serogroups A, B, C, F, and G were determined by latex agglutination test (Murex Streptex kit). RESULTS: Of 627 BHS isolated during the study periods, 16.3% were group A, 49.3% were group B, 5.1% were group C, 4.3% were group F, 21.0% were group G, and 4.0% were nongroupable. Isolation rates of BHS by specimen type were as follows:wound/pus was 44.4%; cervix, urine, and respiratory specimen ranged from 10% to 20%; blood was 4.0%; body fluid was 2.9%; and cerebrospinal fluid was 0.5%. The prevalent isolation sites by serogroup were:group A, wound/ pus (78.4%); group B, cervix (32.7%), urine (28.5%), and wound/pus (26.2%); group C and G, wound/pus and respiratory specimen; and group F, wound/pus and urine. From blood, group B streptococci (44.0%) were the most frequent isolate. CONCLUSIONS: Half of BHS isolated from clinical specimens were group B streptococci in this study, which reflects the increasing trend of group B streptococcal infections during the recent years at Wonju area.

Bacteriologic characteristics and serotypings of Streptococcus pyogenes isolated from throats of school children

To determine the carrier rate of beta-hemolytic streptococci (BHS), throat cultures were taken from healthy elementary school children in four separate areas of Korea from 1992 to 1995, including Inje, Nonsan, Seoul and Chinju. The strains of Streptococcus pyogenes had been serotyped with anti-T, -OF and -M sera. The isolation rates of BHS and S. pyogenes ranged from 14.1-32.4% and 10.9-18.5% respectively. More than half of the carriers showed heavy growth of BHS. M78 (48.6%) and M28 (22.2%) were most common in Inje, M12 (23.6%) and M5 (20.3%) in Nonsan, M12 (48.8%) and M5 (14.6%) in Seoul, and M12 (26.3%) and M22 (14.5%) in Chinju, respectively. About 15% of school children were positive for S. pyogenes in throat cultures, and the distribution of serotypes varied according to geographical regions.

Relationship between Antistreptolysin O Titer and Number of Colonies from Throat Swab Culture Plate in Group A Beta-hemolytic Streptococcal Carriers and Normal School Children

PURPOSE: To know the true carrier rate and the immunologic responses (antistreptolysin O :ASO) to beta-hemolytic streptococci which obtained from normal school children with or without carrying streptococci. And to study the clinical meaning of the number of organisms found in culture. METHODS: One hundred ninty-eight first grade of elementary school children were included. I obtained throat swab culture from tonsil and tonsilar fossa with sterile cotton ball stick and plated on sheep blood agar dish, counted number of colonies of beta-hemolytic streptococci (BHS) after overnight incubation, examined ASO titer (Rantz-Randall method) simultaneously, and differentiated grouping of BHS with Streptex. RESULTS: 1) Of the 198 normal school children, 34 (17.2%) had cultured BHS. 16 (8.1%) were group A, 4 (2.0%) were group C, 2 (1.0%) were group G, and 12 (6.1%) were non-grouping BHS. 2) 14 (22.2%) out of 63 normal children without carrying BHS and 16 (47.1%) out of 34 with carrying BHS had come out above 250 units of ASO. 13 (59.1%) out of 22 group A,C,G streptococcal carriers had showed above 250 units of ASO. The true carrier rate of BHS were 18 (9.0%) out of 198 elementary school children. 3) When I had counted the number of colonies from 34 carrier of BHS, 1+ was 67.6% and 2+ was 17.6%. It was 85.2% of total children with carrier. 4) There were significant differences between the mean titer of logarithmic ASO obtained from group A BHS carrier and that of normal children without carrying BHS (P=0.001), and differences between that of group A and group B,C,G streptococci (P= 0.0005). CONCLUSIONS: The ASO titer obtained from BHS carrier is higher than normal school children, which suggests the possibility of subclinical infection, the possibility of persistent habor of organism since past infection had contracted, and the possibility of replaced old organism in past infection with new organism. It should be performed follow-up study for identifying the persistence of immunologic response in accordance with or without culturing organism.

Bacteriological Survey of beta-Hemolytic Streptococci from the Throats of Elementary School Children in Chinju: Compared with the Results of Children in Kangwon, Chungnam and Seoul

PURPOSE: Throat culture for streptococcal pharyngitis is a gold standard to diagnose, but it may be misleading to interpret due to the carriers. The isolation rates of beta-hemolytic streptococci (BHS) and Streptococcus pyogenes in the school children in Chinju were investigated and compared with those of Kangwon, Chungnam and Seoul previously reported. METHODS: Throat cultures were taken from the healthy 476 elementary school children who had no symptoms or signs of upper respiratory tract infection in April 1995, and the beta-hemolytic streptococci were identified with bacitracin disk (0.04 U) and latex agglutination. RESULTS: One-hundred fifty-four (32.4%) yielded BHS and 88 (18.5%) had S. pyogenes. The serogrouping revealed 30 (6.7%) group G, 24 (5.0%) group C, 4 (0.8%) group B, and 8 (1.7%) non-group A,B,C,G respectively. CONCLUSIONS: The isolation rate of BHS in Chinju was significantly higher (p<0.001) than the results of Kangwon, Chungnam and Seoul. The identification of BHS was also different from the other areas. In addition to these bacteriologic investigation, the study should be followed whether these carriers were simple contact ones or suffered from asymptomatic infections, and the epidemiologic study using serotyping, such as M or T typing, is necessary.

Optimal site of throat swab for the isolation of beta-hemolytic streptococci

The optimal site for the isolation of beta-hemolytic streptococci (BHS) from throat cultures was investigated in 164 healthy elementary school children. All throat cultures were streaked onto duplicate blood agar plates (BAP), one of which was taken from the tonsillar fossae and the other from the posterior pharynx. BHS were isolated in cultures from 56 (34.2%) of the children. BHS were more frequently recovered from the tonsillar fossae than from the posterior pharynx (54 vs. 47; both sites, 45; tonsillar fossae only, 9; posterior pharynx only, 2; P<0.0001). There were significantly more numerous colonies in the tonsillar fossae than in the posterior pharynx (p<0.01). To conclude, the tonsillar fossae are more optimal sites of throat cultures to isolate BHS than the posterior pharynx.

Crude side tomato lectins for identification of group B beta-hemolytic streptococci.

Crude extracte from the side tomato fruit have been shown to contain lectins which specifically bind to group B Beta-hemolytic streptococci. Some additional properties of crude lectins were investigated. The lectins could agglutinate human erythrocytes of type A,B and O. Agglutination was enhanced by trypsin treatment of erythrocytes. The carbohtydrate-binding specificity indicated a specificity of tri-acetyl-glucosamine. They were stable at a high temperature and had a long half-life. The crude lectins agglutinated 149 to 160 strains of group B Beta-hemolytic streptococci with 93.1 percent sensitivity, and did not react with any other of 150 streptococcal sergroups (100% specificity). This finding indicates that the test using crude Sida tomato lectins offers some profound sensitive agglutination technique, they may provide a suitable alternative to other conventional tests for a rapid, simple, cost-effective and specific differentiation of group B from other of Beta-hemolytic streptococci on primary isolation.