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Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study.
- Source :
-
PloS one [PLoS One] 2020 Nov 04; Vol. 15 (11), pp. e0241760. Date of Electronic Publication: 2020 Nov 04 (Print Publication: 2020). - Publication Year :
- 2020
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Abstract
- Background and Objectives: Treatment guidelines do not recommend antibiotic use for acute respiratory infections (ARI), except for streptococcal pharyngitis/tonsillitis and pneumonia. However, antibiotics are prescribed frequently for children with ARI, often in absence of evidence for bacterial infection. The objectives of this study were 1) to assess the appropriateness of antibiotic prescriptions for mild ARI in paediatric outpatients in relation to available guidelines and detected pathogens, 2) to assess antibiotic use on presentation using questionnaires and detection in urine 3) to assess the carriage rates and proportions of resistant intestinal Enterobacteriaceae before, during and after consultation.<br />Materials and Methods: Patients were prospectively enrolled in Children's Hospital 1, Ho Chi Minh City, Vietnam and diagnoses, prescribed therapy and outcome were recorded on first visit and on follow-up after 7 days. Respiratory bacterial and viral pathogens were detected using molecular assays. Antibiotic use before presentation was assessed using questionnaires and urine HPLC. The impact of antibiotic usage on intestinal Enterobacteriaceae was assessed with semi-quantitative culture on agar with and without antibiotics on presentation and after 7 and 28 days.<br />Results: A total of 563 patients were enrolled between February 2009 and February 2010. Antibiotics were prescribed for all except 2 of 563 patients. The majority were 2nd and 3rd generation oral cephalosporins and amoxicillin with or without clavulanic acid. Respiratory viruses were detected in respiratory specimens of 72.5% of patients. Antibiotic use was considered inappropriate in 90.1% and 67.5%, based on guidelines and detected pathogens, respectively. On presentation parents reported antibiotic use for 22% of patients, 41% of parents did not know and 37% denied antibiotic use. Among these three groups, six commonly used antibiotics were detected with HPLC in patients' urine in 49%, 40% and 14%, respectively. Temporary selection of 3rd generation cephalosporin resistant intestinal Enterobacteriaceae during antibiotic use was observed, with co-selection of resistance to aminoglycosides and fluoroquinolones.<br />Conclusions: We report overuse and overprescription of antibiotics for uncomplicated ARI with selection of resistant intestinal Enterobacteriaceae, posing a risk for community transmission and persistence in a setting of a highly granular healthcare system and unrestricted access to antibiotics through private pharmacies.<br />Registration: This study was registered at the International Standard Randomised Controlled Trials Number registry under number ISRCTN32862422: http://www.isrctn.com/ISRCTN32862422.<br />Competing Interests: The authors have declared that no competing interests exist.
- Subjects :
- Amoxicillin pharmacology
Amoxicillin therapeutic use
Amoxicillin urine
Anti-Bacterial Agents therapeutic use
Anti-Bacterial Agents urine
Cephalosporins pharmacology
Cephalosporins therapeutic use
Cephalosporins urine
Child
Child, Preschool
Chromatography, High Pressure Liquid
Drug Prescriptions statistics & numerical data
Drug Resistance, Bacterial
Enterobacteriaceae growth & development
Enterobacteriaceae isolation & purification
Female
Follow-Up Studies
Humans
Infant
Male
Outpatients
Prospective Studies
Respiratory Tract Infections drug therapy
Respiratory Tract Infections pathology
Severity of Illness Index
Vietnam
Anti-Bacterial Agents pharmacology
Enterobacteriaceae drug effects
Gastrointestinal Microbiome drug effects
Respiratory Tract Infections diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 15
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 33147269
- Full Text :
- https://doi.org/10.1371/journal.pone.0241760