Antibióticos en las infecciones respiratorias en urgencias pediátricas hospitalarias / Antibiotics in Respiratory Tract Infections in Hospital Pediatric Emergency Departments

Introducción: Las infecciones respiratorias son un motivo frecuente de consulta en pediatría y originan un gran número de prescripciones de antibióticos. El objetivo de este trabajo es conocer la práctica clínica habitual en relación con el uso de antibióticos en estas patologías en un servicio de urgencias pediátricas hospitalario, así como su adecuación a las guías clínicas. Métodos: Revisión de la base de datos clínicos de las visitas en el servicio de urgencias pediátricas de un hospital de segundo nivel en el período comprendido entre julio de 2005 y octubre de 2007 y análisis del porcentaje de consultas debidas a infecciones respiratorias, analizando las variables: edad, prescripción de antibióticos durante la visita y adecuación de la misma a las recomendaciones internacionales actuales. Resultados: De los 23.114 informes estudiados, el 32,7% (7.567) correspondieron a infecciones respiratorias altas (IRVA) (catarro de vías altas, otitis media aguda [OMA], sinusitis y faringoamigdalitis) o bajas (IRVB) (laringitis, bronquitis, bronquiolitis y neumonía) como diagnóstico principal. El grupo de edad más representado fueron los menores de 2 años. Entre las IRVA, la rinofaringitis fue la más frecuente, y entre las IRVB destacó la bronquitis. Se prescribieron antibióticos, principalmente amoxicilina, en el 30,8% de los casos de IRVA (en el 5,7% de las rinofaringitis, el 96,5% de las otitis medias agudas y el 36,7% de las faringoamigdalitis) y en el 12,4% de las IRVB. Conclusiones: El porcentaje de visitas por cuadros respiratorios infecciosos coincidió con el descrito previamente en estudios similares y la prescripción de antibióticos se ajustó a las recomendaciones actuales, excepto en el caso de la OMA. Es necesario el seguimiento del cumplimiento de la prescripción y de la evolución clínica de los casos

Background: Respiratory tract infections are one of the most frequent problems in pediatric clinics and generate an elevated prescription of antibiotics. The aim of this study was to find out the standard of care practice about antibiotic use in these infections in a pediatric emergency department and to evaluate compliance with clinical guidelines. Methods: A pediatric emergency department database was reviewed from July 2005 to October 2007 under the category "respiratory infection", including variables such as age, antibiotic prescription and compliance with current clinical recommendations. Results: Out of the 23 114 reviewed reports, 32.7% (7567) were upper respiratory tract infections (URTI) (cold, acute otitis media [AOM], sinusitis and tonsillopharyngitis) or lower respiratory tract infections (LRTI) (laryngitis, bronchitis, bronchiolitis and pneumonia). Children under the age of 2 were the most represented age group. Amongst URTI, rhinopharyngitis was the most frequent infection, while bronchitis was the most frequent among LRTI. Antibiotic therapy (mainly amoxicillin) was prescribed in 30.8% of URTI (5.7% rhinopharyngitis, 96.5% AOM, and 36.7% tonsillopharyngitis) and in 12.4% of LRTI. Conclusions: The percentage of respiratory tract infections was similar to previous studies and the antibiotic prescriptions followed current guidelines, except for cases diagnosed with AOM. Prescription compliance and clinical course of the cases should be monitored

Antibiotics in respiratory tract infections in hospital pediatric emergency departments.

BACKGROUND: Respiratory tract infections are one of the most frequent problems in pediatric clinics and generate an elevated prescription of antibiotics. The aim of this study was to find out the standard of care practice about antibiotic use in these infections in a pediatric emergency department and to evaluate compliance with clinical guidelines. METHODS: A pediatric emergency department database was reviewed from July 2005 to October 2007 under the category "respiratory infection", including variables such as age, antibiotic prescription and compliance with current clinical recommendations. RESULTS: Out of the 23,114 reviewed reports, 32.7% (7,567) were upper respiratory tract infections (URTI) (cold, acute otitis media [AOM], sinusitis and tonsillopharyngitis) or lower respiratory tract infections (LRTI) (laryngitis, bronchitis, bronchiolitis and pneumonia). Children under the age of 2 were the most represented age group. Amongst URTI, rhinopharyngitis was the most frequent infection, while bronchitis was the most frequent among LRTI. Antibiotic therapy (mainly amoxicillin) was prescribed in 30.8% of URTI (5.7% rhinopharyngitis, 96.5% AOM, and 36.7% tonsillopharyngitis) and in 12.4% of LRTI. CONCLUSIONS: The percentage of respiratory tract infections was similar to previous studies and the antibiotic prescriptions followed current guidelines, except for cases diagnosed with AOM. Prescription compliance and clinical course of the cases should be monitored.

Indicación de la determinación de los anticuerpos para los virus de la hepatitis C y de la hepatitis A en los protocolos de atención a los niños inmigrantes / Indication of determination of antibodies against hepatitis C and A viruses in the protocol for the care of young immigrants

ObjetivoValorar la determinación sistemática de los anticuerpos para el virus de la hepatitis C (Ac. VHC) y para el virus de la hepatitis A (Ac. VHA) dentro de los protocolo de atención a niños inmigrantes (PANI).MétodosEstudio descriptivo, transversal y multicéntrico. Se determinaron los Ac. VHC y Ac.VHA, en niños de 6 meses a 15 años procedentes de países de baja renta que habían inmigrado hacía menos de 12 meses. Se registró la edad, el sexo y el país de origen. Se ha comparado el coste de la vacunación (con vacuna HA y vacuna HA-HB, precio de sanidad pública y precio de venta al público) a todos los niños inmigrantes sin cribado, con el coste de la vacunación sólo a los no inmunes.ResultadosSe determinaron los Ac. VHC a 1055 niños/as, un caso resultó positivo: 0,09% (IC95%: 0–0,53%). Se determinaron los Ac. VHA a 992 niños/as, y fueron positivos el 38% (IC 95%: 35,0–41,1); en los de América Central y del Sur (n=352) el 34,9%; del Magreb (n=246) el 44,7%; de Indo-Pakistán (n=162) el 58,6%. Según el país de procedencia, la edad y el precio de la vacuna utilizada, es eficiente la determinación de los Ac. VHA previamente a la vacunación para el VHA.ConclusionesLa baja prevalencia de Ac. VHC en población infantil inmigrada no justifica su determinación sistemática. Valorar la determinación de los Ac. VHA en cada niño inmigrante en particular puede aumentar la eficiencia de los PANI (AU)

ObjectivesTo evaluate systematic determination of antibodies against hepatitis C virus (HCV) and hepatitis A virus (HAV) within the protocols for the care of young immigrants (PCYI).MethodsWe performed a descriptive, cross-sectional, multicenter study. Antibodies against HCV and HAV were determined in children aged from 6 months to 15 years from low-income countries who had immigrated to Spain less than 12 months previously. Age, sex and country of origin were registered. The cost of vaccinating all immigrant children (with the HA vaccine and HA-HB vaccine, public health price and retail price) without screening was compared with that of vaccinating non-immune children only.ResultsHCV antibodies were determined in 1055 children and only one was positive [0.09% (95% CI: 0–0.53%)]. HAV antibodies were determined in 992 children and, overall, 38% were positive (95% CI: 35.0–41.1). Distribution by country of origin was as follows: Central and South America (n=352) 34.9%, Maghreb (n=246) 44.7%, and India, Pakistan and Bangladesh (n=162) 58.6%. According to the children's age, country of origin, and the price of the vaccine used, HAV antibody determination in young immigrants before HAV vaccination is efficient.ConclusionsBecause of the low prevalence of HCV antibodies in the pediatric immigrant population, systematic determination is not warranted. Evaluating HAV antibodies in each immigrant child could increase the efficiency of PCYI (AU)

[Indication of determination of antibodies against hepatitis C and A viruses in the protocol for the care of young immigrants]. / Indicación de la determinación de los anticuerpos para los virus de la hepatitis C y de la hepatitis A en los protocolos de atención a los niños inmigrantes.

OBJECTIVES: To evaluate systematic determination of antibodies against hepatitis C virus (HCV) and hepatitis A virus (HAV) within the protocols for the care of young immigrants (PCYI). METHODS: We performed a descriptive, cross-sectional, multicenter study. Antibodies against HCV and HAV were determined in children aged from 6 months to 15 years from low-income countries who had immigrated to Spain less than 12 months previously. Age, sex and country of origin were registered. The cost of vaccinating all immigrant children (with the HA vaccine and HA-HB vaccine, public health price and retail price) without screening was compared with that of vaccinating non-immune children only. RESULTS: HCV antibodies were determined in 1055 children and only one was positive [0.09% (95% CI: 0-0.53%)]. HAV antibodies were determined in 992 children and, overall, 38% were positive (95% CI: 35.0-41.1). Distribution by country of origin was as follows: Central and South America (n=352) 34.9%, Maghreb (n=246) 44.7%, and India, Pakistan and Bangladesh (n=162) 58.6%. According to the children's age, country of origin, and the price of the vaccine used, HAV antibody determination in young immigrants before HAV vaccination is efficient. CONCLUSIONS: Because of the low prevalence of HCV antibodies in the pediatric immigrant population, systematic determination is not warranted. Evaluating HAV antibodies in each immigrant child could increase the efficiency of PCYI.