Association between National Treatment Guidelines for Upper Respiratory Tract Infections and Outpatient Pediatric Antibiotic Use in France: An Interrupted Time-Series Analysis.

OBJECTIVE: To test whether updated clinical practice guidelines for managing upper respiratory tract infections released in France in November 2011 were associated with changes in national outpatient pediatric antibiotic use. STUDY DESIGN: We performed an interrupted time-series analysis using national antibiotic dispensation data in French children from January 2009 to December 2017 (IQVIA Suivi de la Dispensation Médicale database). We described the overall evolution of antibiotic prescription rates and modeled the changes in the proportion of amoxicillin and the proportion of broad-spectrum antibiotics following the guidelines in 2 age groups (0-5 and 6-14 years old). RESULTS: We analyzed 123 million pediatric antibiotic prescriptions. The most commonly prescribed individual antibiotic agent was amoxicillin (37.7%). Over the study period, the annual antibiotic prescription rate decreased by 33.1% (from 1387 to 928 per 1000 pediatric inhabitants per year), consistently across age groups and major antibiotic agents except for amoxicillin (+14.4%). After the release of the guidelines, we observed a gradual increase in the proportion of amoxicillin (relative change 5 years postintervention of +64.3% [95% CI 51.6-80.1] and +28.4% [21.1-36.2] for children 0-5 and 6-14 years, respectively) concomitantly with a gradual decrease in the proportion of broad-spectrum antibiotics (relative change 5 years postintervention of -26.1% [-29.3, -23.7] and -19.8% [-22.1, -16.0] for children 0-5 and 6-14 years old, respectively). CONCLUSIONS: The 2011 guidelines for upper respiratory tract infections preceded changes in outpatient pediatric antibiotic use at the national level, with a replacement of broad-spectrum antibiotics by amoxicillin.

Solvation parameters Part 1. Mutual improvements of several approaches and determination of two first sets of optimized values.

An improvement in the characterization and the determination of the solvation parameters allows, not only a better knowledge of solutions, but also of some biological phenomena. In this paper, we test several published data and approaches in the field of solubility and solvation parameters in two ways: (i) the mutual independence of the parameters and (ii) their ability to take into account recently published gas-liquid chromatographic data. From this enquiry it arises that the most suitable published values are those of Abraham concerning 314 solutes. It also arises that the parameters of dispersion and orientation of this published data set are appreciably improved using two simple equations. In addition, a new set of optimized values for 133 solutes is given, by derivation from retention indices in gas-liquid chromatography (GLC) on five selected stationary phases, published by Kováts and co-workers and in the present study. The two sets have a total of 373 defined compounds.