Antibiotics in respiratory tract infections in hospital pediatric emergency departments.

BACKGROUND: Respiratory tract infections are one of the most frequent problems in pediatric clinics and generate an elevated prescription of antibiotics. The aim of this study was to find out the standard of care practice about antibiotic use in these infections in a pediatric emergency department and to evaluate compliance with clinical guidelines. METHODS: A pediatric emergency department database was reviewed from July 2005 to October 2007 under the category "respiratory infection", including variables such as age, antibiotic prescription and compliance with current clinical recommendations. RESULTS: Out of the 23,114 reviewed reports, 32.7% (7,567) were upper respiratory tract infections (URTI) (cold, acute otitis media [AOM], sinusitis and tonsillopharyngitis) or lower respiratory tract infections (LRTI) (laryngitis, bronchitis, bronchiolitis and pneumonia). Children under the age of 2 were the most represented age group. Amongst URTI, rhinopharyngitis was the most frequent infection, while bronchitis was the most frequent among LRTI. Antibiotic therapy (mainly amoxicillin) was prescribed in 30.8% of URTI (5.7% rhinopharyngitis, 96.5% AOM, and 36.7% tonsillopharyngitis) and in 12.4% of LRTI. CONCLUSIONS: The percentage of respiratory tract infections was similar to previous studies and the antibiotic prescriptions followed current guidelines, except for cases diagnosed with AOM. Prescription compliance and clinical course of the cases should be monitored.

[Indication of determination of antibodies against hepatitis C and A viruses in the protocol for the care of young immigrants]. / Indicación de la determinación de los anticuerpos para los virus de la hepatitis C y de la hepatitis A en los protocolos de atención a los niños inmigrantes.

OBJECTIVES: To evaluate systematic determination of antibodies against hepatitis C virus (HCV) and hepatitis A virus (HAV) within the protocols for the care of young immigrants (PCYI). METHODS: We performed a descriptive, cross-sectional, multicenter study. Antibodies against HCV and HAV were determined in children aged from 6 months to 15 years from low-income countries who had immigrated to Spain less than 12 months previously. Age, sex and country of origin were registered. The cost of vaccinating all immigrant children (with the HA vaccine and HA-HB vaccine, public health price and retail price) without screening was compared with that of vaccinating non-immune children only. RESULTS: HCV antibodies were determined in 1055 children and only one was positive [0.09% (95% CI: 0-0.53%)]. HAV antibodies were determined in 992 children and, overall, 38% were positive (95% CI: 35.0-41.1). Distribution by country of origin was as follows: Central and South America (n=352) 34.9%, Maghreb (n=246) 44.7%, and India, Pakistan and Bangladesh (n=162) 58.6%. According to the children's age, country of origin, and the price of the vaccine used, HAV antibody determination in young immigrants before HAV vaccination is efficient. CONCLUSIONS: Because of the low prevalence of HCV antibodies in the pediatric immigrant population, systematic determination is not warranted. Evaluating HAV antibodies in each immigrant child could increase the efficiency of PCYI.