[Variability in antibiotic prescription in the pediatric population of Castile and Leon (Spain) from 2001 to 2005 in relation to urban or rural setting]. / Variabilidad de la prescripción de antibióticos en la población pediátrica de Castilla y León durante los años 2001 a 2005 en el medio urbano o rural.

OBJECTIVES: To compare systemic antibiotic prescribing in the pediatric population of Castile and Leon in relation to urban or rural setting. MATERIAL AND METHODS: Data on non-hospital antibiotic consumption in the pediatric population were gathered from the database that processes the antibiotics billed in the Health Service of Castile and Leon. These data were analyzed according to the Anatomical Therapeutic Chemical Classification System (ATC) and the results were expressed as defined daily doses per 1000 inhabitants per day (DID). RESULTS: Overall antibiotic consumption in the pediatric population was markedly higher in the rural setting (24.37 DID in rural areas vs. 19.54 DID in urban areas). Interannual variability was similar in both settings, with prescriptions reaching a peak in 2003. In the qualitative analysis, prescription of amoxicillin and, to a lesser extent, of cefixime and azithromycin was higher in rural areas. Differences in prescription in the urban and rural areas of the distinct health areas varied, the greatest differences being found in Segovia. CONCLUSIONS: Wide quantitative and qualitative variability in antibiotic use was found between the various urban and rural zones of basic health areas. Although we suspected that the results for the urban setting would be underestimated due to the excessive use of emergency services, more detailed studies are required to better understand the determinants of antibiotic use in children.

[Analysis of antibiotic consumption in the pediatric population of Castile and León (Spain) from 2001 to 2005]. / Análisis del consumo de antibióticos en la población pediátrica de Castilla y León durante el período 2001 a 2005.

OBJECTIVES: To analyze trends in antibiotic use among the pediatric population of Castile and León from 2001 to 2005. MATERIAL AND METHODS: The antibiotics prescribed to the pediatric population in primary care were processed using the CONCYLIA database. The technical unit of measurement was the defined daily dose (DDD) and the comparative indicator used was the DDD per 1000 inhabitants/day (DID). RESULTS: Overall consumption was high (21.21 DID). Throughout the 5 years of the study we observed substantial variations, especially in 2005, the year in which consumption was highest (25.05 DID). The therapeutic subgroups most frequently prescribed were wide-spectrum penicillins (8.08 DID) and penicillins associated with beta-lactamase inhibitors (7.29 DID), followed by cephalosporins (2.81 DHD) and macrolides (2.52 DHD). The percentage of wide-spectrum penicillin prescription was higher than that of penicillins associated with beta-lactamase inhibitors between 2001 and 2002. These percentages were similar in 2003, and the percentage of wide-spectrum penicillin prescription was lower than that of penicillins associated with beta-lactamase inhibitors in the last 2 years of the study. CONCLUSIONS: Marked differences in consumption were observed over the study period. Changes in patterns of use were found, with an increase in the use of penicillins associated with beta-lactamase inhibitors in the last 2 years of the study.

Detección precoz de la ambliopía en Atención Primaria / Early detection of amblyopia in Primary Care

Introducción: la detección precoz de alteraciones visuales en la infancia tiene importancia ya que pueden causar problemas en el desarrollo visual, el rendimiento escolar o, incluso, suponer un riesgo vital como el retinoblastoma. El objetivo de este estudio es realizar una revisión bibliográfica sobre las actividades diagnósticas que puede realizar el pediatra de Atención Primaria (PAP) para mejorar el cribaje de la ambliopía, e identificar la edad más adecuada para este cribado. Material y métodos: se ha realizado una búsqueda bibliográfica de textos científicos en inglés y español publicados en los últimos 20 años en bases de datos como PubMed y Google Académico. Algunas de las palabras clave fueron: “amblyopia”, “vision screening”, “pediatric”, “retinoscopy” y “photoscreener”. Resultados: se encontraron 376 resultados, seleccionándose 29 artículos y dos libros que incluían métodos diagnósticos de ambliopía realizados por el PAP (Bruckner, Hirschberg, Cover test, estereopsis y agudeza visual) y otros más avanzados (retinoscopia, autorrefractómetros, fotorrefractómetros y potenciales evocados). Los programas de cribado y derivación al oftalmólogo realizados por el PAP están basados en métodos tradicionales, siendo en general poco objetivos y heterogéneos. Conclusiones: los resultados encontrados no definen la edad óptima para el cribado, ni la prueba o combinación de pruebas más adecuadas para evitar derivaciones innecesarias o que una alteración pase inadvertida. Sin embargo, este cribado puede realizarse sencilla y rápidamente a partir de los 6 meses de vida mediante métodos avanzados como fotorrefractometría. Aumentar los recursos disponibles del PAP y conocer su aplicabilidad real y sus beneficios clínicos puede precisar posteriores investigaciones (AU)

Introduction: early detection of visual alterations in childhood has special relevance since it can cause problems in visual development, school performance, or even pose a vital risk such as retinoblastoma. The aim of this study was to conduct a traditional review about the diagnostic procedures that can be performed by the Primary Care Pediatrician (PCP) to improve the screening of amblyopia and to identify the most appropriate age for this screening.Material and methods: a bibliographic search of scientific texts in English and Spanish published in the last 20 years in databases such as PubMed and Google Scholar has been carried out. Some of the key words were: “amblyopia”, “vision screening”, “pediatric”, “retinoscopy” and “photoscreener”.Results: 376 results were found. 29 articles and 2 books were selected covering diagnostic methods of amblyopia performed by the PCP (Bruckner, Hirschberg, Cover test, stereopsis and visual acuity assessment) and others more advanced (retinoscopy, autorefractometry, photorefractometry and evoked potentials). The screening and ophthalmologist referral programs performed by the PCP are based on traditional methods and are generally not very objective and heterogeneous.Conclusions: the evidence does not allow to define the optimal age to amblyopia screening or which test or combination of tests could be the most appropriate to avoid unnecessary referrals or unnoticed alterations. However, this screening can be performed easily and quickly from the age of 6 months using diagnostic methods such as photorefractometry. Increasing the available resources in PCP clinic and knowing its applicability and clinical benefits may require further research. (AU)