Antibiotic Use in Newborns with Transient Tachypnea of the Newborn.

2013

Weintraub AS, Cadet CT, Perez R, Delorenzo E, Holzman IR, Stroustrup A.

Source

Division of Newborn Medicine, Kravis Children's Hospital, Mount Sinai Medical Center, New York, N.Y., USA.

Abstract

Background: Initiation of empiric antibiotic treatment for possible early-onset sepsis is recommended for late preterm and term neonates with respiratory distress. There is no evidence base to this approach. 

Objectives: To determine the incidence of adverse infectious events in neonates with transient tachypnea of the newborn (TTN) managed with a risk-factor-based restrictive antibiotic use policy. 

Methods: This is a single institution retrospective cohort study of neonates with primary diagnosis of TTN between 2004 and 2010. The relationship between antibiotic exposure and infectious outcomes during the neonatal hospitalization was evaluated. An infectious outcome was defined as pneumonia, bacteremia, clinical sepsis, or death. Analysis included t test, χ(2) test, and analysis of variance as appropriate. 

Results: 745 neonates with TTN met inclusion criteria. None of the 494 antibiotic-naive infants, and 212 of the 251 antibiotic-exposed infants had identifiable risk factors for sepsis. No infectious outcomes occurred in infants who did not receive antibiotics. Eight neonates with TTN received full antibiotic treatment for early-onset sepsis. Each was appropriately identified for early receipt of antibiotics based on historical or clinical risk factors for early-onset sepsis. 

Conclusions: This study suggests that empiric postnatal antibiotictreatment may not be warranted for late preterm and term infants with TTN in the absence of specific infectious risk factors.

PubMed

Rampant use of antibiotics making pneumonia a killer

Payal Gwalani, TNN | Nov 6, 2012,

NAGPUR: More incidences of a disease generally equip doctors to manage it better. However, it is the opposite in case of pneumonia, especially the one acquired at the hospitals. Doctors blame indiscriminate use of antibiotics, which has made the pathogens causing this disease more resistant, for making this condition a potentially fatal one.

These were among the many topics discussed during a symposium and clinical meeting of Academy of Medical Sciences on pneumonia held ahead of the World Pneumonia  Day that falls on November 9. While Dr PP Joshi and Dr Amol Sagdeo presented some interesting cases, Dr Ravindra Sarnaik, Dr Sanjeev Mehta, Dr Shrinivas Samavedam, Dr Yagnesh Thakkar and Dr Nainesh Patel  spoke about the various aspects of managing the disease.

President of AMS Dr Rajan Barokar said other than the known viral originated pneumonia, bacterial and fungal pneumonia is increasingly being reported. "Managing pneumonia and its higher form - acute respiratory distress syndrome (ARDS) - is a challenge for the critical care team," he said. Agreeing with this, Dr Chandrashekhar Cham, secretary of AMS, added that secondary infections of this kind acquired at hospitals are emerging as big killers in ICUs. Dr Sarnaik said with many ailments coexisting, the treatment gets more complicated and longer.

Dr Samavedam informed that 40 per cent patients visiting OPD have respiratory infections while 15 per cent have pneumonia. "A lot of cases do not even get reported as they occur at places where medical services may not be well developed," he said. He warned that parents must be cautious when children have fever that persists for more than two days or is acquired after returning from a holiday or after consuming outside food.

Dr Mehta gave the example of France where government rewards the doctors who give least number of antibiotics and make the patients aware about their misuse. "The pathogens that cause hospital acquired infections are immune to many of the common antibiotics. This has given rise to stronger microbes that are lurking around the hospital. Instead of trying different medications, doctors must send the cultures for laboratory tests to decide the course of drugs," said Dr Thakkar.

Dr Patel spoke of a newly emerging form of pneumonia that has resulted from high resistance among the pathogens called health care associated infections. "This means that the disease, even if acquired outside the hospital or in the community, becomes difficult to treat due to resistance from the organisms causing them," he explained.

Dr SK Deshpande blamed lack of hygiene and overcrowded living spaces for this phenomenon. "Urban slums and a general apathy towards cleanliness have made this situation so bad," he said.

Times of India

Etiological diagnosis reduces the use of antibiotics in infants with bronchiolitis.

Etiological diagnosis reduces the use of antibiotics in infants with bronchiolitis.

Sept 2012

Ferronato AE, Gilio AE, Ferraro AA, Paulis Md, Vieira SE.

Source

University Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.

Abstract

OBJECTIVE:

Acute bronchiolitis is a leading cause of infant hospitalization and is most commonly caused by respiratory syncytial virus. Etiological tests are not required for its diagnosis, but the influence of viral screening on the therapeutic approach for acute bronchiolitis remains unclear.

METHODS:

A historical cohort was performed to assess the impact of viral screening on drug prescriptions. The study included infants up to one year of age who were hospitalized for bronchiolitis. Virus screening was performed using immunofluorescence assays in nasopharyngeal aspirates. The clinical data were obtained from the patients' medical records. Therapeutic changes were considered to be associated with viral screening when made within 24 hours of the release of the results.

RESULTS:

The frequency of prescriptions for beta agonists, corticosteroids and antibiotics was high at the time of admission and was similar among the 230 patients. The diagnosis of pneumonia and otitis was associated with the introduction of antibiotics but did not influence antibiotics maintenance after the results of the virus screening were obtained. Changes in the prescriptions were more frequent for the respiratory syncytial virus patients compared to patients who had negative viral screening results (p =0.004), especially the discontinuation of antibiotics (p<0 .001=".001" associated="associated" class="highlight" identification="identification" nbsp="nbsp" of="of" respiratory="respiratory" span="span" style="border: 0px; font-size: 15.600000381469727px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;" suspension="suspension" syncytial="syncytial" the="the" virus="virus" was="was" with="with">antibiotics

 (p= 0.003), even after adjusting for confounding variables (p = 0.004); however, it did not influence the suspension of beta-agonists or corticosteroids.

CONCLUSION:

The identification of respiratory syncytial virus in infants with bronchiolitis was independently associated with the discontinuation of antibiotics during hospitalization.

PubMed

Zinc plus antibiotics saves lives of children with pneumonia, study finds

Zinc plus antibiotics saves lives of children with pneumona, study finds

Publish date: Feb 24, 2012
By: Formulary staff

Zinc used in addition to antibiotics significantly reduced mortality in children ages 6 months to 59 months with severe pneumonia when compared with antibiotics alone, according to the findings of a recent study done in Uganda.

The study, published online February 8 in BMC Medicine, also indicated that the adjunct therapy had a greater effect among HIV-infected children than those who were not infected with HIV.

The double-blind, randomized, placebo-controlled study was led by Maheswari G. Srinivasan, from the Department of Pediatrics and Child Health at the School of Medicine, in Uganda. Researchers enrolled 352 children, aged 6 months to 59 months, who were admitted to the Mulago Hospital pediatric emergency ward with severe pneumonia between September 2006 and March 2007.

"There are 2 key findings in this study: overall, zinc supplementation in these children significantly decreased case fatality, but did not reduce the time to normalization of the parameters for disease severity," the authors stated, noting that these findings come from the secondary objective rather than the primary objectives, which were to assess the effect of zinc as an adjunct therapy on time to normalization of respiratory rate, temperature, and oxygen saturation.

The investigators randomly assigned the children to receive standard antibiotic therapy plus zinc (10 mg for children aged under 12 months; 20 mg for children 12 months and older) or standard antibiotic therapy plus placebo daily. The children were assessed every 6 hours for the first 48 hours and then every 12 hours for 7 days of treatment.

The investigators found no evidence that zinc decreased length of time to recovery. They did, however, note the number of deaths was lower among the children who were treated with zinc (4.0% vs 11.9%; RR=0.33; 95% CI, 0.15-0.76).

In addition, the researchers noted that the effect of zinc supplementation appeared stronger among children infected with HIV. There were more deaths among HIV-positive children assigned to placebo compared with those who received zinc (25.9% vs 0%; RR=0.1; 95% CI, 0.0-1.0).

Among those children who were not infected with HIV and who received placebo, the death rate was 5.5% versus 3.9% among HIV-uninfected children who received zinc (RR=0.7; 95% CI, 0.2-2.2).

“Acute respiratory tract infections are the most common cause of morbidity and deaths in children less than 5 years,” the authors wrote in their background. “Given these results,” the authors stated, “zinc could be considered for use as adjunct therapy for severe pneumonia, especially among Highly Active Antiretroviral Therapy-naïve, HIV-infected children in our environment.”

Modern Medicine