Acute mastoiditis: Increase of incidence and controversies in antibiotic treatment

An important complication of acute otitis media is acute mastoiditis which responds to antibiotic therapy and myringotomy. Patients with acute mastoiditis were reviewed during 1996-2005 in the tertiary University Children’s Hospital in Madrid. The number of patients with acute mastoiditis increased by about 2-fold during this period. Of 205 children with mastoiditis, ranging from 0.6-17 years of age, surgical treatment was needed in about 4.3% in 1996 and in 70% in 2005. In spite of 80% of the children having received antibiotics at the pediatric visit, the number of complications increased (periostitis, subperiosteal abscess), and the number of surgical interventions increased by 8-fold. Etiological agents were Streptococcus pneumoniae (28.5%) and Staphylococcus aureus (16.3%). Negative cultures were obtained in 53.6% of cases. Lack of response to conventional therapy may require more tympanocentesis procedures for a middle ear culture, and surgical therapy may be necessary more often, as is the tendency in our hospital

La mastoiditis aguda es una complicación importante de la otitis media aguda que responde al tratamiento antibiótico y la miringotomía. Se realizó un estudio de revisión de los pacientes con mastoiditis aguda que acudieron al Hospital Infantil Universitario Niño Jesús de Madrid, de nivel terciario, durante 1996-2005. El número de pacientes con mastoiditis aguda aumentó aproximadamente dos veces durante este periodo. De los 205 niños registrados con mastoiditis, con una edad de 0,6 a 17 años, se requirió tratamiento quirúrgico en cerca del 4,3% en 1996 y en el 70% en 2005. A pesar de que el 80% de los niños recibieron antibióticos al visitar al pediatra, el número de complicaciones aumentó (periostitis, absceso subperióstico) y el número de intervenciones quirúrgicas fue hasta ocho veces superior. Los agentes etiológicos identificados fueron Streptococcus pneumoniae (28,5%) y Staphylococcus aureus (16,3%). Los cultivos fueron negativos en el 53,6% de los casos. Según la tendencia observada en nuestro hospital, la falta de respuesta a un tratamiento convencional puede requerir un mayor número de procedimientos de timpanocentesis para los cultivos de oído medio y la necesidad de realizar un tratamiento quirúrgico con mayor frecuencia

[Acute mastoiditis: increase of incidence and controversies in antibiotic treatment].

An important complication of acute otitis media is acute mastoiditis which responds to antibiotic therapy and myringotomy. Patients with acute mastoiditis were reviewed during 1996-2005 in the tertiary University Children's Hospital in Madrid. The number of patients with acute mastoiditis increased by about 2-fold during this period. Of 205 children with mastoiditis, ranging from 0.6-17 years of age, surgical treatment was needed in about 4.3% in 1996 and in 70% in 2005. In spite of 80% of the children having received antibiotics at the pediatric visit, the number of complications increased (periostitis, subperiosteal abscess), and the number of surgical interventions increased by 8-fold. Etiological agents were Streptococcus pneumoniae (28.5%) and Staphylococcus aureus (16.3%). Negative cultures were obtained in 53.6% of cases. Lack of response to conventional therapy may require more tympanocentesis procedures for a middle ear culture, and surgical therapy may be necessary more often, as is the tendency in our hospital.

Meropenem en el tratamiento empírico de infecciones moderadas o graves en niños hospitalizados de 3 a 12 meses y de 1 a 14 años de edad / Meropenem as empirical therapy in moderate to severe infections in hospitalized children aged 3 to 12 months and 1 to 14 years

El objetivo del estudio fue evaluar la dosis, la eficacia y la tolerabilidad del tratamiento con meropenem en pacientes pediátricos con infecciones moderadas a graves. Se realizó un estudio observacional, múlticéntrico y prospectivo en 258 pacientes. Fueron analizados y subdivididos en dos grupos (81 menores de 1 año y 177 entre 1 y 14 años de edad), con seguimiento y control a las 48 horas de comenzar el tratamiento, al final de éste y a la semana de haberlo finalizado. Las infecciones eran de adquisición nosocomial en el 37,5% de los pacientes entre 1 y 14 años, y en el 79,7% de los menores de 1 año (p <0.001). El 79% recibieron 20 mg/kg/8 h de meropenem y un 43,8% recibieron tratamiento combinado con antifúngicos, glucopéptidos o ambos. El 77,4% mostró mejoría clínica a las 48 horas, el 74,2% curaron clínicamente al final del tratamiento y el 77,5% estaban clínicamente asintomáticos a la semana de finalizarlo. La evolución clínica a la curación fue similar en los dos grupos de edad. La erradicación microbiológica se observó en un 76,8%, sin diferencias significativas entre ambos grupos. No se detectaron efectos adversos importantes, a excepción de una pancitopenia en una paciente con protocolo por trasplante hepático al tercer día de tratamiento (AU)

The objective of this study was to evaluate the clinical efficacy, dose and tolerability of treatment with meropenem in children with moderate to severe infections. An observational, multicenter, prospective study of 258 children was conducted. Two cohorts (81 under the age of 1 year, and 177 aged 1 to 14 years) were followed up at 48 hours, at the end of treatment, and 1 week later. Nosocomial infections were present in 37.5% of the children aged 1 to 14 years, and in 79.7% of those younger than 1 year of age (p <0.001). A total of 79% received 20 mg/kg/8 h of meropenem; 43.8% received combination treatment with antifungal agents, glycopeptides or both. At 48 hours, 77.4% showed a clinical improvement; 74.2% were clinically cured at the end of treatment, and 77.5% at 1 week after the end of treatment. The clinical outcome was similar in both groups. Eradication or negative control cultures were found in 76.8%, with no difference between the two age groups. No major adverse events were reported, except for one case of pancytopenia after 2 days of treatment in a patient with a transplanted liver (AU)

Actitud terapéutica ante la patología infecciosa pediátrica en Atención Primaria: tratamiento empírico o tratamiento basado en la evidencia / Therapeutic attitude towards pediatric infectious disease in Primary Health Care: empiric treatment or evidence based treatment

No disponible

[Meropenem as empirical therapy in moderate to severe infections in hospitalized children aged 3 to 12 months and 1 to 14 years]. / Meropenem en el tratamiento empírico de infecciones moderadas o graves en niños hospitalizados de 3 a 12 meses y de 1 a 14 años de edad.

The objective of this study was to evaluate the clinical efficacy, dose and tolerability of treatment with meropenem in children with moderate to severe infections. An observational, multicenter, prospective study of 258 children was conducted. Two cohorts (81 under the age of 1 year, and 177 aged 1 to 14 years) were followed up at 48 hours, at the end of treatment, and 1 week later. Nosocomial infections were present in 37.5% of the children aged 1 to 14 years, and in 79.7% of those younger than 1 year of age (p < 0.001). A total of 79% received 20 mg/kg/8 h of meropenem; 43.8% received combination treatment with antifungal agents, glycopeptides or both. At 48 hours, 77.4% showed a clinical improvement; 74.2% were clinically cured at the end of treatment, and 77.5% at 1 week after the end of treatment. The clinical outcome was similar in both groups. Eradication or negative control cultures were found in 76.8%, with no difference between the two age groups. No major adverse events were reported, except for one case of pancytopenia after 2 days of treatment in a patient with a transplanted liver.

Does short-course antibiotic therapy better meet patient expectations?

A pan-European market research study of 3254 patients designed to determine patient attitudes, expectations and behaviour to antibiotic management of mild-moderate RTIs, identified three key drivers of perceived antibiotic efficacy: length of antibiotic course, time to onset of symptom relief and time to complete resolution of symptoms. Azithromycin was selected as "drug therapy of shortest dosage schedule" for common outpatient infections. The results demonstrate that once-daily, short-course treatment is perceived to be significantly more effective than longer antibiotic courses and thus, better meets patient expectations of therapy. This perception of efficacy with short-course therapy also correlates with overall satisfaction with management by the physician and compliance with therapy. These findings have important implications for the way physicians manage patients with mild-moderate RTIs.

Attitudinal classification of patients receiving antibiotic treatment for mild respiratory tract infections.

The aim of this study was to determine patients' perceptions of antibiotic therapy and the doctor's skill in the management of ambulatory respiratory tract infections. Standardized face-to-face interviews were used with more than 3000 randomized patients or parents from four European countries. Attitudinal dimensions relating to their doctor identified four patient types: Involved (30%), Deferent (23%), Ignored (13%) and Critical (17%). Involved and Deferent patients were the most satisfied by the information received from their doctor (43%/39% compared with 17%/16% for Ignored/Critical, respectively, P < 0.01). They also scored more highly on the accurate use of antibiotics, with 80%/80% vs. 38%/62%, respectively (P < 0.01), understanding dosing intervals and 77%/77% vs. 36%/60% (P < 0.01), understanding the course length. Involved and Deferent patients showed better compliant behaviour, with 91% of both groups vs. 86% of the Ignored and Critical claiming to have taken every dose (P < 0.001) and 92%/87% vs. 84%/85% claiming to have finished the course (P < 0.001 for Involved only). Involved and Deferent patients were less prone to save part of a course of antibiotics than the Ignored and Critical (46%/41% vs. 20%/31%, P < 0.001), and they perceived the antibiotics prescribed to be more effective (36%/31% vs. 21%/15%, P < 0.001). By analysing patient perceptions, this study identifies an important mirror effect, whereby a more sympathetic attitude from the doctor should increase the patient's involvement in disease management, for a more appropriate use of antibiotics in common infections.

[Knowledge, attitude and experience of the Spanish population with respect to antibiotics]. / Conocimiento, actitud y experiencia de la población española respecto a los antibióticos.

Infectious diseases of the upper respiratory tract are one of the most common health problems and antibiotics are used to treat them. The correct use of these drugs depends on a variety of factors: the doctor, the patient and the pharmaceutical industry. The objective of this study was to examine the knowledge, attitude and perception of patients with regard to antibiotics. The study was conducted by carrying out personal interviews with 600 adults and 200 childcare workers who had had a mild to moderate respiratory infection in the two previous months for which an antibiotic was prescribed. In general, the infections had little impact on the everyday lives of the patients, and were mostly categorized as coughing, flu or sore throat. Almost half of the patients waited for the doctor to prescribe an antibiotic when they had an appointment (42% adults and 47% caregivers). A total of 85% of the adults and 71% of the children were treated with penicillin. The majority improved in three days and felt they had recovered in six, a time period which was in accordance with the patients' expectations of the efficacy of the drug. The perception of efficacy was related to a faster initiation of symptomatic improvement or recovery, to short-term treatments, to the information received, and to a better attitude toward their doctor. In general, the patients felt satisfied with the attention they received and related this satisfaction to their trust in their doctor, the efficacy of treatment and the duration of their appointment. The use of antibiotics in mild to moderate respiratory infections is common, and they are often used to treat disease processes that seemingly do not require their use. To improve the use of antibiotics attention needs to be placed on the prescribers and on the consumers.

Conocimiento, actitud y experiencia de la población española respecto a los antibióticos / The Spanish population's knowledge of, attitude towards and experience with antibiotics

Las enfermedades infecciosas de las vías respiratorias altas son uno de los problemas de salud más frecuentes, en cuyo tratamiento se utilizan los antibióticos. El uso correcto de estos fármacos depende de diversos factores: el médico, el paciente, la sociedad y la industria farmacéutica. El objetivo de este estudio es explorar los conocimientos, actitudes y percepción de los pacientes en relación con los antibióticos. El estudio se realizó mediante entrevista personal a 600 adultos y 200 cuidadores de niños que habían padecido una infección respiratoria leve-moderada en los dos meses previos, para la cual se les prescribió un antibiótico. En general, la infección que habían padecido los pacientes tuvo un impacto menor en su vida diaria, etiquetándose en la mayoría de los casos como catarro/tos, gripe o molestias de garganta. Casi la mitad de ellos esperaban que el médico les prescribiera un antibiótico cuando acudieron a consulta (42 por ciento adultos y 47 por ciento cuidadores). El 85 por ciento de los adultos y el 71 por ciento de los niños fueron tratados con penicilinas. La mayoría mejoraron en tres días y se sintieron curados en seis, tiempo acorde a las expectativas de eficacia del paciente hacia el fármaco. La percepción de efectividad se relacionó con una mayor rapidez en el inicio de la mejoría sintomática o la curación, con tratamientos de corta duración, con la información recibida y con la mejor actitud hacia el médico. En general, los pacientes se encuentran satisfechos con la atención recibida, relacionándose esta satisfacción con la confianza en el médico, la efectividad del tratamiento y el tiempo de consulta. El uso de antibióticos en las infecciones respiratorias leves-moderadas es frecuente, a menudo por procesos que presumiblemente no los precisarían. Para mejorar el uso de antibióticos hay que actuar sobre los prescriptores y sobre los consumidores (AU)