Compliance of German pediatric patients with oral antibiotic therapy: results of a nationwide survey.

BACKGROUND: Noncompliance with a prescribed therapy is a common problem in ambulatory pediatrics. OBJECTIVE: To establish a nationwide status quo of compliance of German ambulatory pediatric patients with oral antibiotics prescribed for various bacterial infections. PATIENTS AND METHODS: In this study, organized and financed by the German Society for Pediatric Infectious Diseases, 42 pediatricians in private practice who were selected to represent the 3 main regions of Germany and residence in large cities or small towns, respectively, enrolled consecutive patients who had bacterial infections that required therapy with oral antibiotics. Choice of agent and duration of treatment were left to the study physicians. Compliance was measured by a standardized telephone interview on the penultimate day and a urine bioassay for antibacterial activity on the last day of the planned treatment period. Parents did not know the true purpose of the study. RESULTS: Five hundred eight-four patients were fully evaluable. The most frequent diagnoses included tonsillopharyngitis (n = 231), otitis media (n = 170) and lower respiratory tract infections (n = 114). Most frequently prescribed antibiotics included amoxicillin (n = 102), potassium penicillin V (n = 81) and clarithromycin (n = 67). Overall compliance (positive urine test) on the last day of therapy was 69.5% (406 of 584 patients). Compliance was not significantly influenced by the region of residence or the underlying bacterial infection. It was significantly associated with the antibiotic used (macrolides, 89.0%; penicillins, 62.2%; cephalosporins, 66.4%; P = 0.0001 for macrolides vs. the others). Best compliance was found with clarithromycin (94.0%) and erythromycin estolate (89.8%). Compliance was also significantly better in patients > or =6 years old (77.7%; P = 0.016); with a treatment duration of < or =7 days (77.6%; P = 0.014); when the drug package contained a dose-taking reminder (79.7%; P = 0.003); and when the pediatrician's behavior toward the patient was assessed by the parents as "very sympathetic" or "sympathetic" (72.6%; P = 0.017). Subjecting all variables to logistic regression analysis, we found 3 variables to be significant predictors of treatment compliance: choice of antibiotic (P = 0.0001); patient age (P = 0.0008); and residence in town or city (P = 0.03). CONCLUSIONS: A noncompliance rate of >30% is unsatisfactory. Whereas some variables significantly associated with compliance cannot be influenced (patient age; place of residence in town or city), others are amenable to modifications. These include the physician-patient interaction and the choice of antibiotic. Agents should be preferred that are well-accepted by patients, that enable short-term therapy with few daily doses and with a package that contains a dose-taking reminder.

Compliance of pediatric patients with treatment involving antibiotic suspensions: a pilot study.

In collaboration with 11 German pediatricians in private practice, this pilot study assessed the treatment compliance of 289 pediatric patients (56.1% male: mean age, 53.9+/-35.6 months) who were given antibiotic suspensions (selection and duration determined by the pediatrician) to treat the following bacterial infections: acute otitis media, 34.6%; group A streptococcal tonsillopharyngitis/scarlet fever, 28.7%; lower respiratory tract infection, 18.3%; sinusitis/sinobronchitis, 9.3%; and other infections, 9.0%. The most frequently used antibiotics were amoxicillin (26.3%), erythromycin estolate (19.0%), penicillin V benzathine (14.2%), and cefaclor (13.5%). Compliance was assessed by means of a standardized telephone interview and a urine test that detects antibacterial activity using a Bacillus subtilis spore suspension. Overall compliance (positive urine test result at the end of the planned treatment period) was 79.6% (230 of 289 patients). Compliance was highest with erythromycin estolate (94.5%), followed by penicillin V benzathine (85.4%), cefaclor (76.9%), and amoxicillin (71.1%). Good compliance was also significantly associated with a patient age of > or =3 years and a treatment duration of > or =7 days. Compliance was not significantly influenced by the underlying bacterial infection. In summary, 20.4% of patients were noncompliant when treated with antibiotic suspensions.

[Detection of antibacterial activity in the urine of children: a comparison of three tests]. / Nachweis antibakterieller Hemmstoffe im Urin von Kindern: Vergleich dreier Teste.

BACKGROUND: Detection of antibacterial activity in urine is important for the diagnosis of urinary tract infections and for assessment of patient compliance with antibiotic therapy. METHOD: Urines of paediatric inpatients were examined by the Bacillus subtilis agar diffusion test and two commercial test strips (Micur BT and Urotest AB). RESULTS: 566 urines of 431 patients were examined. The B. subtilis agar diffusion test was the most reliable method (accuracy 98.8%). Micur BT showed a comparatively low specificity (87.6%) and Urotest AB had a comparatively low sensitivity (86.0%). CONCLUSION: The B. subtilis agar diffusion test is the most reliable method for detection of antibacterial activity in the urine of children.

Evaluation of six commercial tests and the germ-tube test for presumptive identification of Candida albicans.

Six commercial tests (Albicans ID, bioMérieux, France; CandiSelect, Sanofi Diagnostics Pasteur, France; CHROMagar Candida, Becton Dickinson, USA; Fluoroplate Candida, Merck, Germany; Fongiscreen 4H, Sanofi Diagnostics Pasteur; and Murex Candida albicans, Murex Diagnostics, USA) and the germ-tube test for presumptive identification of Candida albicans were evaluated using clinical isolates of Candida albicans (n = 350) and of non-albicans yeasts (n = 135). Sensitivities and specificities of all tests regarding the identification of Candida albicans were greater than 97%. The two tests that also allow presumptive identification of some non-albicans yeasts (CHROMagar Candida and Fongiscreen 4H) did not identify all isolates of Candida glabrata and Candida tropicalis. In addition, CHROMagar Candida identified as Candida glabrata some isolates belonging to different species of non-albicans yeasts.

Comparison of three media for agar dilution susceptibility testing of Bordetella pertussis using six antibiotics.

Since antimicrobial susceptibility testing of the fastidious species Bordetella pertussis is not standardized, the most suitable medium for agar dilution testing of this species has not yet been determined. In the present study, Mueller-Hinton, Bordet-Gengou, and Oxoid charcoal agars (each supplemented with 5% horse blood) were evaluated for agar dilution susceptibility testing of Bordetella pertussis against ampicillin, chloramphenicol, ciprofloxacin, doxycycline, erythromycin, and trimethoprim-sulfamethoxazole. Mueller-Hinton agar was the most suitable medium.

[Acute hematogenous osteomyelitis in childhood--correlation of clinical aspects, diagnostic parameters, therapy and prognosis]. / Die akute hämatogene Osteomyelitis im Kindesalter--Korrelation von Klinik, diagnostischen Parametern, Therapie und Prognose.

BACKGROUND: Acute hematogenous osteomyelitis is a common disease in childhood. If treated early, conservative management is possible in most cases. During recent decades, clinical picture, diagnostic techniques and treatment have changed due to various reasons, e.g. previous antibiotic treatment. New laboratory tests and improved imaging techniques such as magnetic resonance imaging enable an earlier diagnosis and thus an earlier onset of treatment and improve the prognosis of hematogenous osteomyelitis. Outcome has also been improved by new antibiotics with enhanced activity against staphylococci. METHOD: The records of 34 children aged 3 weeks to 172 months with acute hematogenous osteomyelitis were evaluated retrospectively. In some cases, the data were completed by phone calls with parents and family physicians. The results were compared with the current literature. RESULTS AND CONCLUSIONS: If diagnosed and treated early, acute hematogenous osteomyelitis in childhood has a good prognosis. For primary diagnosis, the clinical picture, parameters of inflammation and magnetic resonance imaging or scintigraphy are useful. The course of the disease can be assessed by clinical signs and the erythrocyte sedimentation rate. Complications can be recognized by conventional radiography and sonography. Initial antibiotic treatment should be carried out parenterally for at least 3 weeks. An exclusively oral treatment is not recommended.

In vitro susceptibilities of Bordetella pertussis and Bordetella parapertussis to two ketolides (HMR 3004 and HMR 3647), four macrolides (azithromycin, clarithromycin, erythromycin A, and roxithromycin), and two ansamycins (rifampin and rifapentine).

When tested by agar dilution on Mueller-Hinton agar supplemented with 5% horse blood, the ketolides HMR 3004 and HMR 3647 were slightly more active (MIC at which 90% of the isolates were inhibited [MIC90], 0.03 microg/ml) against Bordetella pertussis than azithromycin, clarithromycin, erythromycin A, and roxithromycin. Azithromycin (MIC90, 0.06 microg/ml) was the most active compound against B. parapertussis. Rifampin and rifapentine were considerably less active.

[Pertussis: current aspects of diagnosis, therapy and prevention]. / Pertussis: Aktuelles zu Diagnostik, Therapie und Prävention.

Pertussis (whooping cough) may occur at any age. Beside the typical course of the disease in three stages, atypical courses are observed not infrequently, particularly in adults. In early pertussis, isolation of Bordetella pertussis from nasopharyngeal secretions is the diagnostic method of choice. The polymerase chain reaction is a promising, albeit still investigational diagnostic method. In longstanding cough, serology is the method of choice. Pertussis is treated with erythromycin in high doses for 2 weeks. For prevention of the disease, the new acellular vaccines are to be preferred.

Evaluation of three methods for culturing alginate throat swabs from cystic fibrosis patients.

Deep throat swabs are usually cultured for potential respiratory pathogens in patients with cystic fibrosis (CF) who do not produce sputum. Using alginate swabs, three methods were examined in the present study: (i) semiquantitative processing (direct plating); (ii) mere elution of swabs in Ringer's lactate followed by plating of the eluate; and (iii) complete quantitative processing (elution plus two-step dilution series). Throat swabs from 56 CF patients yielded 122 isolates of potential respiratory pathogens. Semiquantitative processing (n = 101 isolates) was not significantly inferior to elution (n = 104) and quantitative processing (n = 113; p > 0.05). Since semiquantitative processing is the simplest method, it is to be preferred, provided that alginate swabs are used.

Efficacy of a two-component acellular pertussis vaccine in infants.

OBJECTIVE: This case-control study investigated the protective efficacy against pertussis of three doses of a two-component acellular pertussis vaccine (manufactured by Biken in Japan) combined with diphtheria and tetanus toxoids (manufactured by Connaught Laboratories in the US) in infants. METHODS: A case-control study was performed in 63 pediatric practices in Germany. Prospective recruitment of 16,780 infants ages 6 to 17 weeks took place between February, 1993, and July, 1994. According to parental choice infants received either Biken acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTacP) (74.6%) at approximately 2, 4 and 6 months of age, or a licensed German diphtheria-tetanus toxoids-whole cell pertussis vaccine (10.9%), diphtheria-tetanus toxoids vaccine (12.5%) or no vaccine (2.0%). Prospective surveillance of pertussis cases between February, 1993, and May, 1995, was accomplished by culturing all infants < or =2 years of age presenting with cough > or = 7 days. A pertussis case was defined as any cough of 21 days or longer plus a positive Bordetella pertussis culture or household contact exposure. RESULTS: We identified 241 pertussis cases prospectively by 11,017 B. pertussis cultures and 949 controls matched for age were selected from the same pediatric practices. Medical history and demographic and vaccine status data were collected from each case and for four controls. Data were analyzed through conditional logistic regression taking into account individual matching and adjusting for potential confounding variables. DTacP combined with diphtheria and tetanus toxoids vaccine was 82% protective (95% confidence interval, 68 to 90), diphtheria-tetanus toxoids-whole cell pertussis vaccine was 96% protective (95% confidence interval, 78 to 99). Protection against typical B. pertussis infection characterized by paroxysmal cough lasting > or =21 days was 96% (95% confidence interval, 87 to 99) for DTacP and was 97% (95% confidence interval, 79 to 100) for diphtheria-tetanus toxoids-whole cell pertussis vaccine. Adjustment for potentially confounding variables did not change the results significantly. CONCLUSIONS: Three doses of the two-component acellular pertussis vaccine protected infants against pertussis disease during the period before the recommended booster vaccination. For typical pertussis disease as defined by the WHO efficacy was high and similar to that of a licensed German diphtheria-tetanus toxoids-whole cell pertussis vaccine.