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Spain has one of the highest incidences of bacterial resistance to antimicrobials, possibly linked to drug consumption patterns. Using Ministry of Health and Consumer Affairs records, data were obtained on non-hospital sales of antibiotics for the period 1987–1997, and equivalents calculated in weight of active drug ingredient and defined daily doses per 1000 population per day (DDD/1000/day). The number of packages sold declined from 75 million in 1987 to 55 million in 1997. None the less, there was a gradual yet steady rise in consumption in tonnage terms (249 to 275 tonnes). Furthermore, in terms of DDD/1000/day, consumption rose sharply until 1995 and then held steady at 21 DDD/1000/day, a level comparable to the mean for other developed countries. Penicillins were the group to register the highest consumption in Spain, followed—in the latter years of the study—by macrolides, cephalosporins and quinolones. The marked rise in these latter three groups was noteworthy. Despite the decrease in the number of packages sold, antibiotic consumption in Spain has risen. This consumption pattern is different from that of other European countries and might serve to explain differences in the generation of resistance. [ABSTRACT FROM PUBLISHER]

The adequate use of antibiotic drugs depends not only on prescribers but also on patient compliance. We had an aim of assessing the perception of antibiotic treatment by patients (or their parents, for children) in some European countries.Method. – Three thousand representative (quota method) European patients (France, Germany, Italy, Spain) were included in the study. They had all been given antibiotherapy for NARI and answered a questionnaire presented by an enquirer, in a one on one interview.Results. – Four types of patients were identified according to their relationship with the physician: implicated (30%), deferent (23%), indifferent (13%), critical (17%). “Implicated” patients were mostly French and German, “deferent” patients were mostly French and Spanish, “indifferent” patients were mostly Italian. “Implicated” and “deferent” patients were the most satisfied of information given by the physician, 43% and 39% compared to 17% and 16% for “indifferent” and “critical” (P < 0.01). They were more aware of the adequate use of antibiotic drugs 80% and 80% vs. 38% and 62% (P < 0.01). They better understood the frequency of administration and the duration of treatment (77% and 77% vs. 36% and 60%). They were more observant (91% vs. 86%, P < 0.001).Comments. – The physician/patient relationship is correlated to the subjective perception of treatment, but also to prescription observance. The quality of this relationship is essential for an adequate use of antibiotic drugs. [Copyright &y& Elsevier]

Background: In high-resource settings, the survival of children with immunocompromise (IC) has increased and immunosuppressive therapies are increasingly being used. This study aimed to determine the clinical characteristics, performance of diagnostic tools, and outcome of IC children with tuberculosis (TB) in Europe., Methods: Multicenter, matched case-control study within the Pediatric Tuberculosis Network European Trials Group, capturing TB cases <18 years diagnosed 2000-2020., Results: A total of 417 TB cases were included, comprising 139 children who are IC (human immunodeficiency virus, inborn errors of immunity, drug-induced immunosuppression, and other immunocompromising conditions) and 278 non-IC children as controls. Nonrespiratory TB was more frequent among cases than controls (32.4% vs 21.2%; P = .013). Patients with IC had an increased likelihood of presenting with severe disease (57.6% vs 38.5%; P < .001; odds ratio [95% confidence interval], 2.073 [1.37-3.13]). Children with IC had higher rates of false-negative tuberculin skin test (31.9% vs 6.0%; P < .001) and QuantiFERON-TB Gold assay (30.0% vs 7.3%; P < .001) results at diagnosis. Overall, the microbiological confirmation rate was similar in IC and non-IC cases (58.3% vs 49.3%; P = .083). Although the mortality in children with IC was <1%, the rate of long-term sequelae was significantly higher than in non-IC cases (14.8% vs 6.1%; P = .004)., Conclusions: Children with IC and TB in Europe have increased rates of nonrespiratory TB, severe disease, and long-term sequelae. Immune-based TB tests have poor sensitivity in those children. Future research should focus on developing improved immunological TB tests that perform better in patients with IC, and determining the reasons for the increased risk of long-term sequelae, with the aim to design preventive management strategies., Competing Interests: Potential conflicts of interest . B. S. G. and M. T. have received support from Cepheid for a project on molecular tuberculosis diagnostics unrelated to the study reported here. M. T. has received QuantiFERON-TB assays at reduced pricing or free of charge for tuberculosis diagnostics projects from Cellestis/Qiagen in the past and has received support for conference attendance from Cepheid. The manufacturers had no influence on the study design, data collection, analysis or interpretation, writing of the manuscript, or the decision to submit the data for publication. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Tumor-necrosis-factor-α inhibitors (anti-TNF-α) are associated with an increased risk of tuberculosis (TB) disease, primarily due to reactivation of latent TB infection (LTBI). We assessed the performance of parallel LTBI screening with tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube assays (QFT-GIT) before anti-TNF-α treatment in children with immune-mediated inflammatory disorders in a low TB-burden setting. We conducted a multicenter cohort study involving 17 pediatric tertiary centers in Spain. LTBI was defined as the presence of a positive TST and/or QFT-GIT result without clinical or radiological signs of TB disease. A total of 270 patients (median age:11.0 years) were included, mainly with rheumatological (55.9%) or inflammatory bowel disease (34.8%). Twelve patients (4.4%) were diagnosed with TB infection at screening (LTBI, n = 11; TB disease, n = 1). Concordance between TST and QFT-GIT results was moderate (TST+/QFT-GIT+, n = 4; TST-/QFT-GIT+, n = 3; TST+/QFT-GIT-, n = 5; kappa coefficient: 0.48, 95% CI: 0.36-0.60). Indeterminate QFT-GIT results occurred in 10 patients (3.7%) and were associated with young age and elevated C-reactive protein concentrations. Eleven of 12 patients with TB infection uneventfully completed standard LTBI or TB treatment. During a median follow-up period of 6.4 years, only 2 patients developed TB disease (incidence density: 130 (95% CI: 20-440) per 100,000 person-years), both probable de novo infections., Conclusion: A substantial number of patients were diagnosed with LTBI during screening. The dual strategy identified more cases than either of the tests alone, and test agreement was only moderate. Our data show that in children in a low TB prevalence setting, a dual screening strategy with TST and IGRA before anti-TNF-α treatment is effective., What Is Known: • The optimal screening strategy for latent tuberculosis in children with immune-mediated inflammatory disorders remains uncertain. • Children receiving anti-TNF-α drugs are at increased risk of developing severe tuberculosis disease., What Is New: • A dual screening strategy, using TST and an IGRA assay, identified more children with latent tuberculosis than either of the tests alone. • Identification and treatment of latent tuberculosis before initiation of anti-TNF-α therapy averted incident tuberculosis cases., (© 2022. The Author(s).)

Background: In recent years, there is an increasing interest in the use of linezolid for the treatment of tuberculosis (TB)., Methods: Patients less than 18 years of age who received linezolid within the Spanish Pediatric TB Network from 2001 to 2016 were retrospectively included. Treatment characteristics, adverse events (AEs) and outcomes were analyzed., Results: Fifteen children were included (53% male) with a median age of 3.6 years [interquartile range (IQR): 1.6-6.2]. Median follow-up was 54 months (IQR: 38-76). The reasons for linezolid use were drug-resistant TB in 8 (53%) patients, drug-induced liver injury in 5 (33%) patients and chronic liver disease in 2 (13%) patients. Four children (26%) were on immunosuppressive therapy when TB was diagnosed. Five children (33%) were diagnosed with extrapulmonary TB. The median duration of linezolid treatment was 13 months (IQR: 7.5-17). Nine patients had 13 linezolid-related AEs. Hematologic toxicity was observed in 8 patients (53%) and gastrointestinal intolerance in 3 patients (20%). In 2 patients, linezolid dose was reduced, and in 2 patients, linezolid was discontinued because of AEs. A 2-year-old girl went back to her country of birth and was lost to follow-up. No relapses were observed among the other 14 patients (93%)., Conclusions: Linezolid may be considered when treating children with drug-resistant TB but also in the cases of patients with chronic liver disease or drug-induced liver injury. However, AEs should be closely monitored. Further studies are needed to determine the optimum dosage and the optimal duration of linezolid treatment in children.

Acquired hemophagocytic lymphohistiocitosis (HLH) syndrome can be a complication of visceral leishmaniasis (VL). A multicenter prospective study was conducted to determine the frequency of HLH syndrome in children with VL. Twenty-four children with VL were identified, and 10 (41%) developed HLH syndrome. VL should be ruled out in all children with HLH criteria living in or coming from endemic areas.

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.

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.

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.

The use of quinolones has increased remarkably in recent years. Monitoring the trends in the consumption of these antibiotics is essential for the assessment of bacterial resistance. Sales figures for this group of antibiotics for each province from 1985 through 1993 were obtained from the medication database at the Spanish Ministry of Health. The consumption in milligrams per inhabitant older than 15 were calculated for each province and year. Specific time trends in consumption for Spain were studied and provincial maps were made representing consumption in milligrams per person older than 15. Outpatient prescriptions of quinolones increased 155% between 1985 and 1993 in Spain, more than 2 tons per year. Seven of the eight provinces in Andalucia were among the ten provinces with greater consumption. A south-north pattern was detected from year to year. Important increases were observed in all the Spanish provinces. Further studies should consider this fact in the monitoring of antimicrobial resistance and should assess if provincial differences in consumption correlate with the prevalence of the infectious diseases treated with this group of antibiotics.

This document represents the recommendations of a panel of Spanish experts on antibiotic use and resistance. In a Task Force, under the auspices of the Spanish Ministry of Health and Consumer Affairs that took place in 1994 in Madrid, the members were gravely concerned about the national increase in antibiotic resistance. They analysed the development, evolution and spread of antibiotic resistance among community-acquired human bacterial pathogens in Spain, its relation with antibiotic consumption, and they proposed future surveillance strategies for monitoring the patterns of antibiotic use and consumption. Success will require a collective action among the producers (pharmaceutical industry), prescribers (doctors, veterinarians), dispensers (pharmacists), and consumers (patients). Two similar documents have been recently published by the American Society of Microbiology and the World Health Organization showing the global concern about this topic.