No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting.

Background: Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR). Methods: We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome. Results: Among 3166 recruited participants (median age 10 months; interquartile range, 6.5-16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases. Conclusions: In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea.

Development of a semi-quantitative food frequency questionnaire for dietary studies--focus on vitamin C intake.

The present work aimed to provide a basis for examination of intake of selected food items determined with a semi-quantitative food frequency questionnaire (SQFFQ) and planned-food selection (PFS). From February to July of 2003, ninety one cancer patients and 90 matched (same sex and age within 5 years) non-cancer patients were directly interviewed by trained interviewers using the designed questionnaire at the inpatient-department of Viet Duc hospital, Ha Noi City, Viet Nam. Study subjects consumed more SQFFQ-food items than PFS-food items, so that the latter method might not accurately reflect dietary habits regarding estimation of nutrient intake, especially vitamins. Because these are beneficial factors acting against cancer development at many sites, the absence of food items selected by SQFFQ may result in a poor database regarding possible confounding factors. For futher clarification we then focused on vitamin C contributions of Vietnamese food and analyzed data of the National Nutritional Household Survey in 2000: 7,686 households throughout the country (vitamin C intake status) and 158 households with 741 persons of the population of Hanoi city (individual food items contributing to vitamin C). Direct interview using a validated questionnaire with an album of current Vietnamese food items-recipes and weighing checks was conducted to obtain information regarding all types of food intake over the last 24-hours. Contribution analysis using the Nutritive Composition Table of Vietnamese Foods, revision 2000, and stepwise regression analysis was applied. Average intake adjusted by ages of vitamin C per person per day was estimated. In total, the study subjects were found to currently consume 184 food items. Average intake of vitamin C was 72.5 mg per person per day at the national level: 57.9% from leafy vegetables, 33.4% from fresh fruits, and 6.4% from non-leafy vegetables. For vitamin C contribution, the highest 25 food items contributed to a cumulative 95.3% of vitamin C intake with a cumulative R2=0.99.