Implementation of a Multifaceted Program to Improve the Rational Use of Antibiotics in Children under 3 Years of Age in Primary Care.

A multifaceted, participatory, open program based on a qualitative and quantitative approach was developed in the Region of Murcia (Spain) aimed to reduce antibiotic use in children under 3 years of age diagnosed with upper respiratory tract infections (acute otitis media, pharyngitis, and common cold). Antibiotic consumption was measured using the defined daily dose per 1000 inhabitants per day (DHD). Pre-intervention data showed a prevalence of antibiotic prescriptions in the primary care setting of 45.7% and a DHD of 19.05. In 2019, after the first year of implementation of the program, antibiotic consumption was 10.25 DHD with an overall decrease of 48% as compared with 2015. Although antibiotic consumption decreased in all health areas, there was a large variability in the magnitude of decreases across health areas (e.g., 12.97 vs. 4.77 DHD). The intervention program was effective in reducing the use of antibiotics in children under 3 years of age with common upper respiratory diseases, but reductions in antibiotic consumption were not consistent among all health areas involved.

Early estimates of nirsevimab immunoprophylaxis effectiveness against hospital admission for respiratory syncytial virus lower respiratory tract infections in infants, Spain, October 2023 to January 2024.

The monoclonal antibody nirsevimab was at least 70% effective in preventing hospitalisations in infants with lower respiratory tract infections (LRTI) positive for respiratory syncytial virus (RSV) in Spain (Oct 2023-Jan 2024), where a universal immunisation programme began late September (coverage range: 79-99%). High protection was confirmed by two methodological designs (screening and test-negative) in a multicentre active surveillance in nine hospitals in three regions. No protection against RSV-negative LRTI-hospitalisations was shown. These interim results could guide public-health decision-making.

Clinical characteristics, health care resource utilization and direct medical costs of Rotavirus hospitalizations in Spain (2013-2018).

Rotavirus (RV) is the most common cause of severe gastroenteritis (GE) in infants and young children worldwide and is associated with a significant clinical and economic burden. The objective of this study was to analyze the characteristics, healthcare resource utilization and the direct medical costs related to RVGE hospitalizations in Spain. An observational, multicenter, cross-sectional study was conducted from June 2013 to May 2018 at the pediatric departments of 12 hospitals from different Spanish regions. Children under 5 years of age admitted to the hospital with a confirmed diagnosis of RVGE were selected. Data on clinical characteristics, healthcare resource use and costs were collected from patient records and hospital databases. Most children hospitalized for RVGE did not have any previous medical condition or chronic disease. Forty-seven percent had previously visited the Emergency Room (ER), 27% had visited a primary care pediatrician, and 15% had received pharmacological treatment prior to hospital admission due to an RVGE episode. The average length of a hospital stay for RVGE was 5.6 days, and the mean medical costs of RVGE hospitalizations per episode ranged from 3,940€ to 4,100€. The highest direct medical cost was due to the hospital stay. This study showed a high burden of health resource utilization and costs related to the management of cases of RVGE requiring hospitalization. RV vaccination with high coverage rates should be considered to minimize the clinical and economic impacts of this disease on the health-care system.

Impact of Pneumococcal Vaccination in the Nasopharyngeal Carriage of Streptococcus pneumoniae in Healthy Children of the Murcia Region in Spain.

BACKGROUND: An epidemiological study of Streptococcus pneumoniae nasopharyngeal carriage in healthy children was carried out five years after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). OBJECTIVES: Study the impact of pediatric vaccination with PCV13, and other associated epidemiological factors on the status of nasopharyngeal carriage, the circulating pneumococcal serotypes, and the antibiotic susceptibility to more frequently used antibiotics. METHODS: A multi-center study was carried out in Primary Health Care, which included 1821 healthy children aged 1 to 4 years old. All isolates were sent to the Spanish Pneumococcal Reference Laboratory for serotyping and antimicrobial susceptibility testing. RESULTS: At least one dose of PCV13 had been received by 71.9% of children and carriage pneumococcal prevalence was 19.7%. The proportion of PCV13 serotypes was low (14.4%), with an observed predominance of non-vaccine serotypes, 23B, 11A, 10A, 35B/F, and 23A were the five most frequent. A high rate of resistance to penicillin, erythromycin, and trimethoprim sulfamethoxazole was found. CONCLUSIONS: A low proportion of PCV13 serotypes were detected, confirming the impact of pediatric vaccination for reducing the serotypes vaccine carriage. High resistance rates to clinically important antibiotics were observed.

Rational use of antimicrobials in the treatment of upper airway infections / Uso racional de antimicrobianos no tratamento de infecções das vias aéreas superiores

Abstract Objective To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self-limited, and typically viral condition: upper airway respiratory infections. Sources Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients. Summary of the findings Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones. Conclusions Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials.

Resumo Objetivo Analisar a principal causa do uso irresponsável de antibióticos em nível pediátrico de doenças muito frequentes, normalmente autolimitadas e virais: infecções respiratórias das vias aéreas superiores. Fontes Diferentes bases de dados foram pesquisadas com termos específicos relacionados à resistência a antibióticos, infecções respiratórias das vias aéreas superiores e pacientes de pediatria. Resumo dos achados A eficácia varia, depende do local, da forma e dos recursos usados. As formas de múltiplas intervenções parecem mais eficazes. O treinamento em aspectos técnicos e habilidades de comunicação para médicos e tempo suficiente para cada paciente, além do treinamento por meio da clínica e da mídia para pacientes/pais, são a base da eficácia. Prescrições de uso posterior e testes de diagnóstico rápido no ambiente de cuidado primário mostraram ser eficazes. Uma relação de confiança entre médicos e pais ou responsáveis é uma das pedras angulares. Conclusões Qualquer projeto que busque ser completamente eficaz deve incluir uma autoridade em saúde, que, além de ajudar a implantar as medidas nos pacientes, tem a sólida intenção de reduzir drasticamente o uso de antibióticos em animais e no meio ambiente, além de favorecer a pesquisa sobre novos antimicrobianos.

Rational use of antimicrobials in the treatment of upper airway infections.

OBJECTIVE: To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self-limited, and typically viral condition: upper airway respiratory infections. SOURCES: Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients. SUMMARY OF THE FINDINGS: Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones. CONCLUSIONS: Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials.

Epidemiology of Nasopharyngeal Carriage by Haemophilus influenzae in Healthy Children: A Study in the Mediterranean Coast Region.

BACKGROUND: Haemophilus influenzae, a colonizer of the nasopharynx, in children causes mainly otitis and sinusitis. The primary objective of this study was to determine the prevalence of pharyngeal colonization by H. influenzae, and the secondary objectives were to identify risk factors associated with H. influenzae colonization and its antibiotic susceptibility. METHODS: A prospective, multicenter study of nasopharyngeal carriers of H. influenzae was conducted in the pediatric consulting rooms of 10 primary healthcare centers in Murcia (Spain). The study consisted of 404 healthy children less than 5 years of age and was carried out during winter (January-March) and summer (July-September) of 2015. A nasopharyngeal sample was collected from each child, and an epidemiologic survey was completed by a pediatrician. RESULTS: In total, 112 (27.7%) children had colonization by H. influenzae, with 73.2% of cases in winter and 26.8% of cases in summer (P < 0.001). The median (interquartile range) age in months of the colonized children (13 months, 12-47.5) was lower than that of the noncolonized children (46 months, 12-49) (P < 0.001). All H. influenzae found were nontypeable H. influenzae (NTHi). Among 112 isolates, 20% were ampicillin resistant, of which 10% produced ß-lactamase, and 9% were ampicillin resistant and did not produce ß-lactamase. A logistic regression analysis showed that young age (odds ratio: 0.98) and the winter period (odds ratio: 3.41; P < 0.001) were risk factors for colonization by NTHi. CONCLUSIONS: Colonization by NTHi is high in this Mediterranean coast region with remarkable ampicillin resistant. Younger age and the winter period were facilitating factors.

[Epidemiological study of nasopharyngeal carriers of Streptococcus pneumoniae in children in Murcia region]. / Estudio epidemiológico de portadores nasofaríngeos de Streptococcus pneumoniae en niños en la comunidad autónoma de Murcia.

BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae is a human pathogen that requires prior nasopharyngeal colonization to cause disease. An epidemiological study was conducted on nasopharyngeal carriers of pneumococci in healthy children in Murcia after the introduction of the VCN7, and immediately before the marketing of new vaccines, with the aim of determining the influence of vaccination in our geographic area, and other factors in relation to the state of being a carrier, and the different circulating serotypes. METHODS: A multicentre study was conducted in in 60 primary care health centres in summer 2009 and winter of 2010. A nasopharyngeal swab was collected, and an epidemiological study was carried out on 1562 children aged 1 and 4 years. Of the 1562 nasopharyngeal samples, pneumococci were found in 489 of them, with 343 of them able to be serotyped (70.2%). RESULTS: The prevalence of carriers was 31.3%. Of the patients included, 61.7% (964/1562) had received at least one dose of VCN7. Only 12.8% of the identified serotypes were vaccine serotypes. The independent protective factors against colonization were; Summer time in all age groups, previous vaccination in all the children (OR: 0.75; 95%CI: 0.56-0.93]; P=.01, and in 1-year-olds (OR: 0.6; 95%CI: 0.42-0.84; P=.002), and had taken antibiotics in the last month in the total cohort [OR: 0.69; 95%CI: 0.50-0.96). On the other hand, attendance at school or day-care centre (OR: 1.85; 95%CI: 1.27-2.18; P=.001), number of siblings (OR: 1.3; 95%CI: 1.01-1.91), and passive tobacco smoke exposure (OR: 1.33; 95%CI: 1.02-1.73), were colonization risk factors. The serotypes 6A, 19A, 23B, 15A/B, 11A, 14, 23A/F, 3 y 19F were the most prevalent. CONCLUSIONS: A low proportion of SV was found, with 14, 23F and 19F are persisting. A high prevalence of serotypes 6A and 19A was found. Summer time, vaccination, and the prior administration of antibiotics proved to be protective against colonization, whereas schooling, smoking, and siblings contributed to it.

Enterovirus reverse transcriptase polymerase chain reaction assay in cerebrospinal fluid: an essential tool in meningitis management in childhood.

BACKGROUND: Enteroviruses (EV) are the main aetiological agents of aseptic meningitis in children and a common cause of febrile illnesses in young infants in summer. A rapid diagnosis is essential to rule out other conditions. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay performed in cerebrospinal fluid (CSF) has proved to be a very fast and useful tool. METHODS: We collected demographic, clinical and laboratory data of children (aged 11-years or younger) with EV RT-PCR (Cepheid(®) Xpert EV) positive in CSF from December 2007 to July 2010, to describe EV meningitis in children and to determine the role of this assay. RESULTS: We included 92 children (mean age 2.5 years), 32% of whom were neonates. There was no pleocytosis in the CSF of 18.5% (36% in newborn) of the patients, and 23 (25%) were discharged to home from the Emergency Room after the positive results. Length of hospital stay was 2 days (>2 years) versus 4.5 days in newborns (P<0.0001). Antibiotic treatment was prescribed in 38% (75% <3 months), but in 40% of these, it was stopped after the positive results. Mean EV RT-PCR information time was 7h (4-18h). All children had a good clinical outcome. CONCLUSIONS: EV RT-PCR assay in CSF has played an essential role in the management of children with EV meningitis, allowing earlier discharges and decreasing avoidable inappropriate antibiotic treatments. This test should be considered as part of the initial study of children with aseptic meningitis, especially during epidemic seasons.