The effect of rapid diagnostic testing for influenza on the reduction of antibiotic use in paediatric emergency department.

AIM: To determine the influence of rapid diagnosis of influenza on antibiotic prescribing to children presenting with influenza-like illness in the emergency department in a inner city hospital in Istanbul, Turkey. METHODS: Patients aged 3 to 14 years presenting to an urban children's teaching hospital emergency department were screened for fever and cough, coryza, myalgias and/or malaise. After obtaining informed consent, patients were allocated into two groups. Group 1: patients were prescribed antibiotics after only physical examination; or Group 2: patients were prescribed antibiotics after rapid influenza testing. Nasopharyngeal swabs obtained from all patients were immediately tested in a single-blind manner with Influenza A/B Rapid Test(R) for influenza A and B. RESULTS: A total of 97 patients were enrolled, and 33 (34%) of these tested positive for influenza. Although frequency of positive results for influenza between the groups was similar (36% vs 32%, respectively), patients in Group 2 were less likely to be prescribed antibiotics when compared to those in Group 1 (32% vs 100%, respectively, p < 0.0001). CONCLUSION: Rapid diagnosis of influenza in the paediatric emergency department may allow a significant reduction in the over-prescription of antibiotics.

Congenital Agranulocytosis (Kostmann's Syndrome) and G-CSF Therapy in an Infant.

Congenital agranulocytosis (Kostmann's Syndrome) is a rare autosomal recessive inherited disorder characterised by severe neutropenia, recurrent infections, and death in early life, with the bone marrow showing a maturation arrenst of myeloid cells at the myelocyte stage. The treatment of Kostmann's Syndrome with G-CSF results in rapid improvement. However, a few unexpected results with the use of G-CSF, were reported. Here, we describe a 7-month-old female with Kostmann's Syndrome who had recurrent skin infections and a large pyogenic infection in the supravulvar region. The patient was treated with G-CSF successfully at low doses. The infectious process and the quality of lite of the patient improved. There was no adverse effect due to the dosage and the duration. Currently bone marrow transplantation is the best way to treat Kostmann's Syndrome. Nevertheless, our experience showed that G-CSF treatment in Kostmann's syndrome was highly effective and successfull on a short term basis.