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.

Publicaciones científicas: presente y futuro / Scientific Publications: Present and Future

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[Hospital admission in newborns according to ethnicity and parents' country of origin in an urban area of Barcelona [Spain]]. / Ingreso hospitalario de los recién nacidos según el origen étnico y el país de procedencia de los progenitores en una área urbana de Barcelona.

OBJECTIVE: The birth rate in Spain has increased due to the continuous rise in the number of immigrants. Ethnic origin and socioeconomic position can be determining factors in differences in maternal and child health. The aim of the present study was to determine the possible existence of differences in neonatal diagnoses according to parental ethnic origin. METHODS: We performed a retrospective, cross-sectional study of all live newborns delivered in Hospital del Mar (Barcelona) between 2003 and 2005. The variables studied were risk of admission, diagnostic classes, and parental ethnic group. RESULTS: Of the 2118 newborns included in this study, 46.7% were of immigrant origin (mainly from Central and South America) and 6.4% were gypsies. More than 60% of the 1445 admitted newborns were included in the diagnostic class of risk or suspicion of infection. The risk of pregnancy with little or no prenatal care was higher in non-native and gypsy newborns (OR = 2.58; 95%CI: 1.76-3.77, and OR = 5.84; 95%CI: 3.45-9.90, respectively). The risk of low birth weight and maternal drug use were lower in non-native newborns (OR = 0.17; 95%CI: 0.03-0.90, and OR = 0.12; 95%CI: 0.03-0.44, respectively). CONCLUSIONS: Differences in non-native and gypsy newborns compared with native newborns are not due to imported or genetic diseases but are probably due to differences in the social and cultural environment during pregnancy. Preventive measures should be promoted and reinforced and access to and the quality of primary care should be improved in these mothers and their infants.

Ingreso hospitalario de los recién nacidos según el origen étnico y el país de procedencia de los progenitores en una área urbana de Barcelona / Hospital admission in newborns according to ethnicity and parents' country of origin in an urban area of Barcelona [Spain]

Objetivo: El aumento continuado de la inmigración ha ocasionadoun incremento de la natalidad a expensas de este grupode población. El origen étnico y el nivel socioeconómico puedenser factores que condicionen las diferencias de salud maternoinfantil.El objetivo fue conocer si hay diferencias en los diagnósticosneonatales según el origen étnico de los progenitores.Métodos: Estudio transversal retrospectivo de los recién nacidosvivos en el Hospital del Mar (Barcelona) entre 2003 y2005. Las variables estudiadas fueron: riesgo de ingresar, categoríasdiagnósticas y grupo étnico de los progenitores.Resultados: El 46,7% de los 2.118 recién nacidos eran inmigrantes(mayoritariamente de Centroamérica y Sudamérica)y el 6,4% gitanos. En más del 60% de los 1.445 reciénnacidos ingresados, la categoría diagnóstica más frecuentefue el riesgo o la sospecha de infección. Los recién nacidosno autóctonos y gitanos tuvieron más riesgo de embarazo pocoo no controlado (odds ratio [OR] = 2,58; intervalo de confianzadel 95% [IC95%]: 1,76-3,77, y OR = 5,84; IC95%: 3,45-9,90,respectivamente). Los recién nacidos no autóctonos tuvieronmenos riesgo de bajo peso al nacimiento (OR = 0,17;IC95%: 0,03-0,90) y consumo materno de tóxicos (OR= 0,12; IC95%: 0,03-0,44).Conclusiones: Las diferencias en las categorías diagnósticasen los recién nacidos no autóctonos y gitanos, comparadoscon los autóctonos, no se deben a enfermedades importadaso a diferente carga genética, sino que posiblementeson consecuencia del entorno social y cultural de la gestante.Sería necesario reforzar y promover el uso de medidas preventivasde salud, así como mejorar el acceso y la calidad dela asistencia a estas mujeres y sus hijos(AU)

Objective: The birth rate in Spain has increased due to thecontinuous rise in the number of immigrants. Ethnic origin andsocioeconomic position can be determining factors in differencesin maternal and child health. The aim of the presentstudy was to determine the possible existence of differencesin neonatal diagnoses according to parental ethnic origin.Methods: We performed a retrospective, cross-sectional studyof all live newborns delivered in Hospital del Mar (Barcelona)between 2003 and 2005. The variables studied were risk ofadmission, diagnostic classes, and parental ethnic group.Results: Of the 2118 newborns included in this study, 46.7%were of immigrant origin (mainly from Central and South America)and 6.4% were gypsies. More than 60% of the 1445 admittednewborns were included in the diagnostic class of riskor suspicion of infection. The risk of pregnancy with little orno prenatal care was higher in non-native and gypsy newborns(OR = 2.58; 95%CI: 1.76-3.77, and OR = 5.84; 95%CI: 3.45-9.90, respectively). The risk of low birth weight and maternaldrug use were lower in non-native newborns (OR = 0.17;95%CI: 0.03-0.90, and OR = 0.12; 95%CI: 0.03-0.44, respectively).Conclusions: Differences in non-native and gypsy newbornscompared with native newborns are not due to imported orgenetic diseases but are probably due to differences in thesocial and cultural environment during pregnancy. Preventivemeasures should be promoted and reinforced and accessto and the quality of primary care should be improved in thesemothers and their infants(AU)