ABSTRACT
West Virginia consistently ranks in the top two nationally for per capita antibiotic prescription rates in both pediatric and adult outpatient populations. We present the first descriptive analysis evaluating outpatient prescription rates within the WV pediatric Medicaid population, which demonstrated significant antibiotic prescribing variability by provider type, specialty, and geography.
Subject(s)
Antimicrobial Stewardship , Adult , Anti-Bacterial Agents/therapeutic use , Child , Humans , Medicaid , Outpatients , United States , West Virginia/epidemiologyABSTRACT
We present the first published case of raltegravir-associated drug-reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a child without characteristic human leukocyte antigen haplotypes HLA-B*57:01 or HLA-B*53:01. A 4-year-old African American female with perinatally acquired human immunodeficiency virus infection was hospitalized for DRESS after starting a raltegravir-based antiretroviral regimen.
Subject(s)
Drug Hypersensitivity Syndrome , Eosinophilia , Pharmaceutical Preparations , Alleles , Child , Child, Preschool , Drug Hypersensitivity Syndrome/genetics , Eosinophilia/chemically induced , Female , HLA Antigens , HLA-B Antigens/genetics , Humans , Raltegravir Potassium/adverse effectsABSTRACT
We present here the first published use of letermovir for the treatment of resistant cytomegalovirus (CMV) in a pediatric patient. A 14-year-old girl underwent a double unrelated umbilical cord blood transplantation to treat her sickle cell disease (hemoglobin SS) and developed ganciclovir-resistant CMV DNAemia with end-organ involvement that was treated successfully with a combination of foscarnet and letermovir. After she was transitioned to letermovir monotherapy for secondary prophylaxis, she developed recurrent DNAemia with laboratory-confirmed ganciclovir, foscarnet, and letermovir resistance.
Subject(s)
Acetates/therapeutic use , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/drug therapy , Hematopoietic Stem Cell Transplantation , Quinazolines/therapeutic use , Salvage Therapy , Adolescent , Drug Resistance, Viral , Female , Humans , Immunocompromised HostABSTRACT
PURPOSE OF REVIEW: The majority of pediatric antibiotic use occurs in outpatients. However, the optimal strategies for antimicrobial stewardship in this setting are unknown. We sought to identify studies relevant to pediatric outpatient stewardship that have been published in the past decade. The details of this systemic review are presented along with targets for future stewardship efforts and discussion regarding effective outpatient stewardship strategies. RECENT FINDINGS: In 2016, the CDC released the "Core Elements of Outpatient Antibiotic Stewardship" that serve as practical guidelines to develop impactful and sustainable ASP interventions: commitment, action for policy and practice, tracking and reporting, and education and expertise. However, there has not been a recent review of the primary medical literature on pediatric outpatient stewardship. A systematic review of pediatric antibiotic control strategies published in 2007 identified 28 studies overall, 8 of which focused on outpatients. Two subsequent systematic reviews published in 2015 and 2018 intentionally excluded outpatients. Outpatient settings are a crucial component of pediatric antimicrobial stewardship in the USA. Establishing effective stewardship interventions can protect children and optimize clinical outcomes in outpatient healthcare settings. Based on our review of the literature, it is clear that the optimal outpatient stewardship strategies remain to be elucidated. However, there is robust literature describing variability in outpatient antibiotic prescribing that can be used to target interventions.
