It's a rash: Antibiotic allergies in the modern era of antibiotic stewardship.
Int J Pediatr Otorhinolaryngol
; 143: 110638, 2021 Apr.
Article
em En
| MEDLINE
| ID: mdl-33561701
ABSTRACT
OBJECTIVES:
To determine whether current guidelines emphasizing antibiotic stewardship in pediatrics have been associated with reduced prevalence of antibiotic allergies in children severely affected by otitis media undergoing bilateral myringotomy with tympanostomy tube insertion (BMT) or by recurrent sinusitis or adenotonsillitis undergoing adenoidectomy with or without tonsillectomy.METHODS:
Case series of consecutive patients undergoing BMT or adenoidectomy with/without tonsillectomy for recurrent acute otitis media, recurrent sinusitis, or recurrent tonsillitis during November 2008 or November 2017 at a tertiary care children's hospital. Children with primarily obstructive indications for surgery, with prior tube placement or adenoidectomy, or with surgery by an outside provider were excluded. Demographics, type of surgery, and allergies or allergic symptoms were collected from the electronic medical record. Factors associated with antibiotic allergies were compared using logistic regression, Wilcoxon rank-sum, or Chi-squared test.RESULTS:
Seventy-five children who underwent surgery during 2008 and 75 children who underwent surgery in 2017 were included. Overall, median age at surgery was 3.24 years (range 0.56-17.49 years). Seventy-nine (52.7%) patients were female and 95 (63.3%) had private insurance. BMT was the most common surgery (82 children, 54.7%) followed by tonsillectomy with adenoidectomy (46 children, 30.7%), and adenoidectomy without tonsillectomy (39 children, 26.0%). Symptoms of allergic rhinitis were reported by 53 (35.3%) patients, and 11 (7.3%) and 5 (3.3%) had positive environmental and food allergy testing, respectively. Surprisingly, there was not a significant difference between the prevalence of antibiotic allergies in patients undergoing surgery during 2017 (17 patients, 22.7%) compared with 2008 (14 patients, 18.7%) (OR 1.28, 95% CI 0.578-2.82, p = 0.546). However, antibiotic allergies were less common in females (OR 0.413, 95% CI 0.182-0.937, p = 0.034) and more common in patients with a family history of antibiotic allergies (OR 36.9, 95% CI 5.12-∞, p < 0.001).CONCLUSION:
Pediatric otolaryngology surgical patients continue to exhibit a similar and high prevalence of antibiotic allergies in 2017 compared with 2008. Future studies are needed to determine whether this is because of overdiagnosis of antibiotic allergies or a failure of antibiotic guideline adherence to reduce antibiotic allergy prevalence.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Exantema
/
Gestão de Antimicrobianos
Tipo de estudo:
Risk_factors_studies
Limite:
Adolescent
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Child
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Child, preschool
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Female
/
Humans
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Infant
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Male
Idioma:
En
Revista:
Int J Pediatr Otorhinolaryngol
Ano de publicação:
2021
Tipo de documento:
Article