Prescription of antibiotics for mild acute respiratory infections in children

Acute respiratory infections (ARI), the leading class of ailments causing people to seek health care, rarely require antibiotics. Nevertheless, many phisycians prescribe them needlessly. Hence, reducing the unnecessary use of antibiotics is one aim of any ARI control program. To help determine whether this aim might be achieved through a combination of refresher training for family phisycians and public education campaing, two 1991 interventions were carried out in four health areas (designated A, B, C and D) in the city of Habana, Cuba. In each area, 10 clinics staffed by family physicians were selected through simple random sampling. In two areas (A and B), a refresher training program on ARI for health personnel was instituted at each clinic, while in areas A and C a community education program was set up. No intervention was carried out in area D. Simultaneously, from January through Dicembre 1991 trained individuals visited and administered a standard questionnaire every 15 days to 1 600 families (40 per clinic) systematically selected by random sampling. The aim of this procedure was to record the number of ARI episodes ocurring among children under 5 years old, the treatment chosen in these cases, and whether antibiotics were employed. The results showed that when the two interventions were iniciated, antibiotics were prescribed for 26 per cent, 20 per cent, 11 per cent, and 19 per cent of the mild ARI cases occurring in areas A,B,C and D respectively (P 0.05). In the period immediately following the interventions, antibiotics prescription rates declined by 26 per cent and 63 per cent in areas A and B, while increasing by 2 per cent and 48 per cent in areas C and D. Overall, prescription of antibiotics in the intervention areas A and B combined decreased by 54 per cent (95 per cent CI: 31-69 per cent). These data suggest that a refresher training program for health personnel can rapidly reduce the unnecessary prescribing of antibiotics for ARI cases, but that public education alone does not appear effective

Prescripción de antibióticos para infecciones respiratorias agudas leves en niños / Prescription of antibiotics for mild acute respiratory infections in children

Las infecciones respiratorias agudas (IRA), que son la primera causa de atención en los servicios de salud, pocas veces requieren antibióticos. No obstante, muchos médicos los recetan sin necesidad. Reducir el uso innecesario de antibióticos es, por consiguiente, uno de los objetivos de todo programa de control de las IRA. Con el fin de determinar si este objetivo podía lograrse mediante la recapacitación de médicos de familia y la educación del público, en 1991 se llevaron a cabo dos intervenciones en cuatro áreas de salud- denominadas A,B,C, y D- de la Ciudad de la Habana, Cuba. Por muestreo aleatorio simple se escogieron en cada área 10 consultorios atendidos por médicos de familia. En las áreas A y B se puso en marcha en cada consultorio un programa de recapacitación sobre las IRA para el personal de salud, y en las áreas A y C un programa de educación comunitaria. En el área D no hubo ninguna intervención. Simultáneamente, de enero a diciembre de 1991 personas entrenadas visitaron y les aplicaron cada 15 días un cuestionario estándar a 1600 familias (40 por cada consultorio) elegidas por muestreo aleatorio sistemático. El objeto fue investigar el número de episodios de IRA en niños menores de 5 años, el tratamiento adoptado y el uso de antibióticos. Los resultados revelaron que en el momento de iniciarse las dos intervenciones, la prescripción de antibióticos para casos de IRA leves en las áreas A,B,C y D era de 26,20,11, y 19 por ciento respectivamente (P0.05) (AU)

Efecto protector de los antibióticos en el riesgo de morir de niños mexicanos con infecciones respiratorias agudas / Protective effect of antibiotics among mexican children at risk of dying from acute respiratory infections

Se realizó un estudio de casos y controles para evaluar el efecto de los antibióticos sobre la mortalidad infantil por infecciones respiratorias agudas (IRA). De noviembre de 1986 a mayo de 1987, se incluyeron en el estudio 49 porciento de las defunciones por IRA de un área de la ciudad de México y de cuatro rurales del estado de Tlaxcala. Los rubros 460-466 y 490 de la Clasificación Internacional de Enfermedades, Revisión de 1975. El 68 porciento de las defunciones ocurrieron en el hogar y en los barrios más pobres, y 49 porciento se registraron en menores de seis meses de edad. Los controles fueron niños que habian padecido un episodio grave de IRA. Estos se seleccionaron entre los vecinos de los casos mediante una encuesta. Los criterios de inclusión de los casos y los controles fueron clínicos y temporales. Los casos y los controles se aparearon según la edad y la fecha de inicio de la enfermedad. Con la ayuda de un muestrario de medicamentos, se interrogó a los familiares de los casos y los controles sobre el uso de antibióticos. El riesgo de los casos de no haber recibido antibióticos fue mayor que el de los controles (razón de productos cruzados ajustada según diversos factores de confusión RPC-= 28,5; intervalo de confianza de 95 porciento (IC95 percent: 2,1-393,4)

The rational use of drugs in the management of acute diarrhoea in children / The rational use of drugs in the management of acute diarrhoea in children

An estimated 4 million children under 5 years of age die annually as a direct result of diarrhoea, and many other from causes that are aggravated by diarrhoea. Adequate feeding during and after diarrhoeal episodes and timely action to prevent or treat dehydration could substantially reduce these numbers, yet the inappropriate or injudicious use of drugs frequently diverts attention and resources away from these meaures. A number of pharmaceutical agents have been, and continue to be, promoted for the treatment of acute diarrhoea. At best, many of these are of questionable therapeutic value, and at worst they may be positively harmuful. This book reviews experimental and clinical experience of the use of a range of these agents. Extensive evidence is cited in support of its conclusions- that use of adsorbents or of drugs purporting to reduce intestinal motility cannot be justified, and that paediatric use of antibiotics and antiparasitics should be strictly confined to cases of diarrhoea of specific etiology

Epidemiology and control of gonococcal ophthalmia neonatorum

From a public health point of view gonococcal ophthalmia neonatorum (GCON) is important as it can rapidly lead to blindness. The frequency of GCON is determined by the prevalence of maternal gonococcal infection. In most industrialized countries the prevalence of gonorrhoea in pregnant women is less than 1 per cent; in developing countries the rates are between 3 per cent and 15 per cent, more than 50 per cent being due to penicillinase-producing Neisseria gonorrhoeae strains (PPNG). The rate of transmission from mother to newborn is between 30 per cent and 50 per cent

Strategies for the control of GCON include: (1) prevention of gonococcal infection in women of childbearing age, (2) detection and treatment of gonococcal infection in pregnant women, (3) eye prophylaxis in the newborn at birth, and (4) diagnosis and treatment of GCON. Eye prophylaxis by the instillation immediately after birth of either 1 per cent silver nitrate eye drops or 1 per cent tetracycline eye ointments is very effective. This reduces the GCON incidence by 80 per cent to 95 per cent and is highly cost-effective, particularly in high-risk settings(AU)