Appropriate antibiotic prescribing pattern in hospitalized children.

This study analyzes prospectively the antibiotic prescription habits in terms of appropriateness of use and cost pattern effects in the paediatric wards of two different university hospital patient set-ups. Data on demographics, discharge diagnosis, antibiotic utilization and costs were collected prospectively from the children's individual electronic charts at Rambam Health Care Campus (R) and Kaplan Medical Centre (K) in Israel. A total of 505 and 497 children from R and K units, respectively, were screened. Of the surveyed population, 239 and 330 children in the R and K units were hospitalized due to infectious diseases. The antibiotic appropriateness for the R and K units were 84% and 91%, respectively (p>0.5). Total antibiotics Defined Daily Dose (DDD) and Drug Utilization 90% (DU90%) index were 241.7 and 217.5 for the R unit and 388 and 349.2 for the K unit, (p<0.001). Drug Cost 90% indices (DC90%) for the two units were NIS 6,023.5 and NIS 5,955.8; respectively. This study generates up-to-date information on the antimicrobial prescription habits in two different hospitals and suggests that antibiotic treatment in both hospitals appears to be appropriate. Significant lower median antibiotic cost was depicted in the K admission unit in comparison to the R admission unit (11.3 NIS - 40.0 NIS; p<0.01), respectively. Drug use evaluations are useful indicators for following trends of drug prescription, optimizing antibiotic usage and controlling expenditure.

[Brown recluse bite].

Spider bites are not uncommon in our warm climate. The most prevalent species of venomous spiders in Israel are the brown recluse and the black widow. Although the black widow is more notorious than the recluse, for every bite by a black widow there are hundreds of recluse bites reported. Despite the numerous bites, there is little awareness amongst physicians with regard to the clinical signs of recluse bites, and very often the wrong diagnosis is made, resulting in complex and unnecessary treatments. The basis of this error stems from the numerous clinical diagnoses which closely imitate a recluse bite, the relative scarceness of documented recluse bites and the fact that in most cases the spider is not witnessed by the victim. The following article describes three cases of children admitted to our department, presenting with high fever, a necrotic lesion and an extensive maculopapular rash. The children were eventually diagnosed with brown recluse bites. Furthermore, the article summarizes the literature regarding the clinical signs of recluse bites, possible complications and treatment options. The objective of this review is to increase awareness towards recluse bites, thereby preventing misdiagnoses and unnecessary treatments.