Management Of Acute Respiratory Infections Research Articles

NSAIDs for early management of acute respiratory infections.

To review the rationale for and the potential clinical benefits of an early approach to viral acute respiratory infections with NSAIDs to switch off the inflammatory cascade before the inflammatory process becomes complicated. It has been shown that in COVID-19 as in other viral respiratory infections proinflammatory cytokines are produced, which are responsible of respiratory and systemic symptoms. There have been concerns that NSAIDs could increase susceptibility to SARS-CoV-2 infection or aggravate COVID-19. However, recent articles reviewing experimental research, observational clinical studies, randomized clinical trials, and meta-analyses conclude that there is no basis to limit the use of NSAIDs, which may instead represent effective self-care measures to control symptoms. The inflammatory response plays a pivotal role in the early phase of acute respiratory tract infections (ARTIs); a correct diagnosis of the cause and a prompt therapeutic approach with NSAIDs may have the potential to control the pathophysiological mechanisms that can complicate the condition, while reducing symptoms to the benefit of the patient. A timely treatment with NSAIDs may limit the inappropriate use of other categories of drugs, such as antibiotics, which are useless when viral cause is confirmed and whose inappropriate use is responsible for the development of resistance.

Commentary on the adoption of a test-based versus syndromic-based approach to outbreak declaration and management in hospital and institutional settings.

At present, Ontario, like most other jurisdictions in Canada, uses a syndromic-based surveillance definition for acute respiratory infection (ARI) outbreaks in institutions and public hospitals. Confirmed outbreaks are defined as either two or more ARIs in 48 hours with any common epidemiological link and at least one that is laboratory-confirmed; or three cases of ARIs occurring within 48 hours with any common epidemiological link, and not necessarily with lab confirmation. However, with the adoption of broader test-based approaches for sick patients/residents throughout the pandemic, new challenges have surfaced regarding the declaration and management of ARI outbreaks with a variety of scenarios in respiratory testing results. Decisions, including the determination of epidemiological linkage when there are discordant/negative test results, have become more complicated with the addition of virus-specific test results for every sick individual. The ARI outbreak case definition and management guidance was updated in 2018. The purpose of this commentary is to highlight epidemiological trends in ARI outbreaks in Ontario over the 2022-2023 season compared to the 2018-2019 and 2019-2020 pre-pandemic seasons. This is followed by a discussion around some of the benefits and challenges of implementing a test-based versus syndromic-based approach to ARI outbreaks.

Pattern of Antibiotic Use Among Children With Acute Respiratory Infections in Saudi Arabia: Clinical Assessment.

This study aimed to evaluate the common clinical diagnoses and treatment management of acute respiratory infections (ARIs) in children and determine when antibiotics are recommended and prescribed. A retrospective review of medical charts was carried out at King Salman Bin Abdulaziz Medical City (KSAMC) Hospital to assess pediatric patients diagnosed with ARIs aged 0-14 years, excluding those requiring antibiotics for conditions other than ARIs. Data, including demographic diagnoses and treatment management, were extracted using consecutive sampling, and statistical analyses were conducted using Jamovi software. A total of 285 pediatric patients were included, with a median age of 3 (IQR = 1-6) years and a male predominance of 59.2%. Bronchopneumonia was the most common respiratory disease, diagnosed in 39.1% of participants. The median durations for illness and hospital admission were four and three days, respectively. Clinical evaluations showed an average respiratory rate of 28±10.5 breaths per minute and a mean oxygen saturation of 96.4±3.46% through pulse oximetry. The use of antibiotics was commonly prescribed in ARI patients only when accompanied by certain bacterial infections (46.32%). ARIs are a common viral health issue among children, emphasizing that not all ARIs in children are caused by bacteria and that antibiotics should only be used when there is a bacterial infection present. Enhanced diagnostic precision, patient awareness, and provider education are the global community's recommendations to prevent the presence of antibiotic resistance and the irrational use of antibiotics.

Differential Diagnosis in the Management of Acute Respiratory Infections through Point-of-Care Rapid Testing in a Post-Pandemic Scenario in Latin America: Special Focus on COVID-19, Influenza, and Respiratory Syncytial Virus

This review provides a comprehensive summary of evidence to explore the role and value of differential diagnosis in the management of Acute Respiratory Infections (ARIs) through point-of-care (POC) rapid testing in a post-pandemic scenario, paying particular attention to coronavirus disease 2019 (COVID-19), influenza, and respiratory syncytial virus (RSV). The document builds on a review of literature and policies and a process of validation and feedback by a group of seven experts from Latin America (LATAM). Evidence was collected to understand scientific and policy perspectives on the differential diagnosis of ARIs and POC rapid testing, with a focus on seven countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. The evidence indicates that POC rapid testing can serve to improve ARI case management, epidemiological surveillance, research and innovation, and evidence-based decision-making. With multiple types of rapid tests available for POC, decisions regarding which tests to use require the consideration of the testing purpose, available resources, and test characteristics regarding accuracy, accessibility, affordability, and results turnaround time. Based on the understanding of the current situation, this document provides a set of recommendations for the implementation of POC rapid testing in LATAM, supporting decision-making and guiding efforts by a broad range of stakeholders.

Principal Component Patterns of Pediatric Respiratory Viral Testing Across Health Care Settings.

Factors prompting clinicians to request viral testing in children are unclear. We assessed patterns prompting clinicians to perform viral testing in children discharged from an emergency department (ED) or hospitalized with an acute respiratory infection (ARI). Using active ARI surveillance data collected from November 2017 through February 2020, children aged between 30 days and 17 years with fever or respiratory symptoms who had a research respiratory specimen tested were included. Children's presentation patterns from their initial evaluation at each health care setting were analyzed using principal components (PCs) analysis. PC-specific models using logistic regression with robust sandwich estimators were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between PCs and provider-ordered viral testing. PCs were assigned respiratory virus/viruses names a priori based on the patterns represented. In total, 4107 children were enrolled and tested, with 2616 (64%) discharged from the ED and 1491 (36%) hospitalized. In the ED, children with a coviral presentation pattern had a 1.44-fold (95% CI, 1.24-1.68) increased odds of receiving a provider-ordered viral test than children showing clinical symptoms less representative of coviral-like infection. Whereas children in the ED and hospitalized with rhinovirus-like symptoms had 71% (OR, 0.29; 95% CI, 0.24-0.34) and 39% (OR, 0.61; 95% CI, 0.49-0.76) decreased odds, respectively, of receiving a provider-ordered viral test during their medical encounter. Viral tests are frequently ordered by clinicians, but presentation patterns vary by setting and influence the initiation of testing. Additional assessments of factors affecting provider decisions to use viral testing in pediatric ARI management are needed to maximize patient benefits of testing.

Edukasi Pencegahan dan Tatalaksana Awal Infeksi Saluran Pernapasan Akut pada Anak

Acute Respiratory Infection (ARI) is an infection that can occur in the respiratory tract. The World Health Organization (WHO) in 2015 stated that, ARI is the leading cause of death in children less than 5 years old in the world. This service aims to improve the degree of public health knowledge through counseling on the importance of prevention and early management of ARI in children. This method of service is to conduct an initial survey of the location of the service, conduct counseling related to the initial management and prevention of ARI in children accompanied by discussions at the Gambesi Health Center. The target of this devotion is mothers who have toddler children. The result obtained is that there is an increase in maternal knowledge before and after counseling is carried out

Effect of Effective Cough on Sputum Expulsion in Patients with ARI (Acute Respiratory Infection)

ISPA or ARI (Acute Respiratory Infection) is an acute respiratory illness that lasts about 14 days and usually affects the throat, nose and lungs. A frequent problem in patients with acute respiratory infections is the inability to clear secretions from the airways which can lead to ineffective airway clearance. One of the non-pharmacological management of ARI can be done with effective cough training. The purpose of this study was to determine the effect of effective cough on sputum discharge in patients with ARI at Sumber Kasih General Hospital, Cirebon City in 2022.
 This research design uses pre experiment with one group pre test-post test design. The research subjects were 90 ARI patients at Sumber Kasih General Hospital, Cirebon City with the sampling technique used was accidental sampling. The research instrument was a sputum discharge observation sheet. 
 The results of the study obtained data from the pretest results showed that sputum discharge in patients with ARI before effective cough training was carried out in the outgoing category, namely 54 people (60%). While the results of the posttest showed that sputum discharge in patients with ARI after effective coughing exercises with the outgoing category was 81 people (90%). Based on the results of the Wilcoxon test, the significance value (sig.2-tailed) <0.05 (p=0.000), then based on the decision-making criteria, Ha is accepted, meaning that effective cough training can increase sputum discharge in patients with ARI at Sumber Kasih General Hospital, Cirebon City.
 It is hoped that nurses can provide education about effective cough training to increase sputum discharge in patients with ARI, so that patients with ARI are able to practice it at home

Edukasi Pemberian Terapi Uap Sederhana untuk Bersihan Jalan Napas Tidak Efektif pada ISPA

Acute respiratory infection (ARI) is one of the public health problems that is important to pay attention to. ARI is an infection that occurs in the respiratory tract, both upper and lower respiratory tract. This infection can cause symptoms of cough, runny nose, and fever. The problem that often arises in this ARI is ineffective airway clearance due to hypersecretion in the respiratory tract. Interventions are carried out to maintain a patent airway so that you can breathe spontaneously without difficulty, pain is reduced and oxygen needs are met. One of the efforts to overcome airway clearance is not effective because of nasal congestion can be done with simple steam therapy with eucalyptus oil. This community service aims to train the community's independence in dealing with health problems experienced, especially related to ARI with simple steam therapy with eucalyptus oil. This activity was carried out on December 19, 2021 in Sesela village, West Lombok district with 43 participants. The method of implementation is through lectures, discussions and demonstrations. The results of the evaluation of this activity showed that participants were able to understand and understand the meaning, signs and symptoms, causes and management of ARI and understand and know how to do simple steam therapy with eucalyptus oil.

Viral and Atypical Pathogen's Epidemiology of a Large Cohort of Patients with Acute Respiratory Tract Infections in Shaanxi Province, Northwest China.

To analyze and summarize the etiological and epidemiological characteristics of acute respiratory tract infections (ARIs) in northwest China to improve the clinical management and prevention of local ARIs. Patients with ARIs in Shaanxi Province, from January 2014 to December 2018, were retrospectively analyzed. Indirect immunofluorescence assay (IFA) was used to detect the IgM antibody of eight respiratory pathogens. A total of 15,543 eligible patients were included in this study. Overall, 36.01% of the patients (5597/15543) were positive for at least one of eight pathogens, among which single and mixed infections accounted for 74.65% (4178/5597) and 25.35% (1419/5597), respectively. Mycoplasma (MP) showed the highest detection rate (18.12%), followed by influenza virus B (Flu B, 11.65%), chlamydia (CP, 7.00%), respiratory syncytial virus (RSV, 4.18%), parainfluenza virus (PIV, 2.83%), influenza virus A (Flu A, 1.69%), legionella (LP, 1.00%) and adenovirus (ADV, 0.70%). Flu B (17.54%, 759/4327) was the most prevalent virus in patients aged less than 18 years. In addition, common respiratory infections with higher detection rates were found in autumn (39.65%), followed by winter (37.37%), summer (36.21%) and spring (30.91%). There were significant differences in the detection rates of pathogens in different seasons (P < 0.001). These findings serve as a reference for local health authorities to develop further plans for the prevention and control of ARIs.

Family Knowledge About the Management of Acute Respiratory Infection (ARI) in Toddlers in the Children's Clinic of the Madani Hospital

This study aims to determine the level of family knowledge about the management of Acute Respiratory Infection (ARI) in toddlers at the Madani Hospital Polyclinic, Central Sulawesi Province. This type of research is descriptive. The variable in this study was family knowledge about the management of ARI in toddlers. The types of data in this study are primary data and secondary data. The analysis used in this research is univariate analysis. The population in this study were families who brought toddlers with ARI to seek treatment at the Children's Polyclinic at Madani General Hospital in Central Sulawesi Province at the time the study was conducted. The sample is 43 people with accidental sampling technique. The results showed that of the 43 respondents, 55.8% had good knowledge, 39.5% had sufficient knowledge and 4.7% lacked knowledge. Most of the family's knowledge about the management of ARI in toddlers is good. Suggestions are expected for health workers at the Madani Public Hospital Children's Polyclinic to be more proactive in taking preventive measures related to ARI in toddlers, so that the morbidity and mortality due to ARI will decrease.

Costs of management of acute respiratory infections in older adults: A systematic review and meta-analysis.

Acute respiratory infections (ARIs) accounted for an estimated 3.9 million deaths worldwide in 2015, of which 56% occurred in adults aged 60 years or older. We aimed to identify the cost of ARI management in older adults (≥50 years) in order to develop an evidence base to assist decision-making for resource allocation and inform clinical practice. We searched 8 electronic databases including Global Health, Medline and EMBASE for studies published between January 1, 2000 and December 31, 2021. Total management costs per patient per ARI episode were extracted and meta-analysis was conducted by World Health Organization (WHO) region and World Bank income level. All costs were converted and inflated to Euros (€) (2021 average exchange rate). The quality of included studies and the potential risk of bias were evaluated. A total of 42 publications were identified for inclusion, reporting cost data for 8 082 752 ARI episodes in older adults across 20 countries from 2001 to 2021. The majority (86%) of studies involved high-income countries based in Europe, North America and Western Pacific. The mean cost per episode was €17 803.9 for inpatient management and €128.9 for outpatient management. Compared with costs reported for patients aged &amp;lt;65 years, inpatient costs were €154.1, €7 018.8 and €8 295.6 higher for patients aged 65-74 years, 75-84 years and over 85 years. ARI management of at-risk patients with comorbid conditions and patients requiring higher level of care, incurred substantially higher costs for hospitalization: €735.9 and €1317.3 respectively. ARIs impose a substantial economic burden on health systems, governments, patients and societies. This study identified high ARI management costs in older adults, reinforcing calls for investment by global health players to quantify and address the scale of the challenge. There are large gaps in data availability from low-income countries, especially from South East Asia and Africa regions.

Modelling the cost-effectiveness of pulse oximetry in primary care management of acute respiratory infection in rural northern Thailand.

We aimed to determine the cost-effectiveness of supplementing standard care with pulse oximetry among children <5 years with acute respiratory infection (ARI) presenting to 32 primary care units in a rural district (total population 241,436) of Chiang Rai province, Thailand, and to assess the economic effects of extending pulse oximetry to older patients with ARI in this setting. We performed a model-based cost-effectiveness analysis from a health systems perspective. Decision trees were constructed for three patient categories (children <5 years, children 5-14 years, and adults), with a 1-year time horizon. Model parameters were based on data from 49,958 patients included in a review of acute infection management in the 32 primary care units, published studies, and procurement price lists. Parameters were varied in deterministic sensitivity analyses. Costs were expressed in 2021 US dollars with a willingness-to-pay threshold per DALY averted of $8624. The annual direct cost of pulse oximetry, associated staff, training, and monitoring was $24,243. It reduced deaths from severe lower respiratory tract infections in children <5 years by 0.19 per 100,000 patients annually. In our population of 14,075 children <5 years, this was equivalent to 2.0 DALYs averted per year. When downstream costs such as those related to hospitalisation and inappropriate antibiotic prescription were considered, pulse oximetry dominated standard care, saving $12,757 annually. This intervention yielded smaller mortality gains in older patients but resulted in further cost savings, primarily by reducing inappropriate antibiotic prescriptions in these age groups. The dominance of the intervention was also demonstrated in all sensitivity analyses. Pulse oximetry is a life-saving, cost-effective adjunct in ARI primary care management in rural northern Thailand. This finding is likely to be generalisable to neighbouring countries with similar disease epidemiology and health systems.

Viral etiology among children hospitalized for acute respiratory tract infections and its association with meteorological factors and air pollutants: a time-series study (2014–2017) in Macao

BackgroundThe associations between viral etiology of acute respiratory infections (ARI) with meteorological factors and air pollutants among children is not fully understood. This study aimed to explore the viral etiology among children hospitalized for ARI and the association of meteorological factors and air pollutants with children hospitalization due to viral ARI.MethodsElectronic health record data about children (aged between 1 month and 14 years) admitted for ARI at Kiang Wu Hospital in Macao between 2014 and 2017 was analyzed retrospectively. xMAP multiplex assays were used to detect viruses in the nasopharyngeal swab and distributed-lag nonlinear model (DLNM) was used to evaluate associations.ResultsAmong the 4880 cases of children hospitalization due to ARI, 3767 (77.2%) were tested positive for at least one virus and 676 (18%) exhibited multiple infections. Enterovirus (EV)/rhinovirus (HRV), adenovirus (ADV), respiratory syncytial virus (RSV) and influenza virus (IFV) were the most common viral pathogens associated with ARI and human bocavirus (hBOV) exhibited the highest multiple infection rates. Meteorological factors and air pollutants (PM10, PM2.5 and NO2) were associated with the risk of viral ARI hospitalization. The relative risk of viral infection increased with daily mean temperature but plateaued when temperature exceeded 23 °C, and increased when the relative humidity was < 70% and peaked at 50%. The effect of solar radiation was insignificant. Air pollutants (including PM10, PM2.5, NO2 and O3) showed strong and immediate effect on the incidence of viral infection.ConclusionsThe effects of mean temperature, relative humidity and air pollutants should be taken into account when considering management of ARI among children.

Етіотропна противірусна терапія ГРІ та грипу

Наведено досвід ведення гострих респіраторних інфекцій (ГРІ), грипу в 2009–2016 рр., перелік інфекційних і неінфекційних ускладнень ГРІ, грипу, об’єктивних досліджень і показань до госпіталізації. Основна стратегія лікування ГРІ, грипу полягає в застосуванні етіотропних противірусних препаратів (ЕПП) — осельтамівіру, занамівіру, Інгавірину. Зроблено висновок про необхідність раннього прийому ЕПП. Наведена дихальна підтримка при гострому ушкодженні легенів, гострому респіраторному дистрес-синдромі із застосуванням неінвазивної і інвазивної вентиляції легенів.

Outpatient Management of Acute Respiratory Infections in Children

Background. Antimicrobial resistance is one of the most crucial problems in human health care worldwide. The main cause of this crisis is the excessive and misuse of antibacterial drugs (ADs). The highest rate of improper antibiotics' prescriptions in pediatric practice is observed at treatment of respiratory tract infections in outpatient clinics.Objective. The aim of the study is to analyze the clinical practice of management of patients with acute respiratory infections (ARI) and the use of ADs in children's outpatient clinics across the regions of Russian Federation.Methods. Multicenter retrospective study was conducted. All ARI cases documented in 969 medical records (form 112/y) of children born in 2015–2017 yy. in 16 regions of Russian Federation (selected randomly) were analyzed.Results. Acute viral infection was diagnosed in 79.6% cases of referencing to doctor with ARI symptoms. Systemic ADs were prescribed in 23% cases of ARI. Antibacterial therapy was received by 14% of children diagnosed with acute respiratory viral infection, 35% with acute laryngotracheitis, 80% with acute bronchitis, 76% with acute rhinosinusitis, 94% with ARI associated with otitis media, 52% with tonsillopharyngitis, and 100% with community-acquired pneumonia. Amoxicillin (35%), amoxicillin/clavulanic acid (24%), azithromycin (20.2%) were prescribed most often. Parenteral administration of ADs was prescribed in 3.9% of cases, mostly for children with community-acquired pneumonia. Prescribed antibacterial therapy was unreasonable in 84% of analyzed cases. Polypragmasy occurred in 50.5% of cases. Clinical protocols violations were mostly common for management of patients with laryngotracheitis and tonsillopharyngitis.Conclusion. There is favorable trend towards the decrease in ADs prescribing frequency in outpatient clinics for children with ARI. Thus, polypragmasy and irrational choice of antibacterial therapy frequency remains quite high.

Adherence to Guidelines of Integrated Management of Childhood Illness in Management of Acute Respiratory Infection in an Urban Maternal and Child Health Center-Egypt

Adherence to Guidelines of Integrated Management of Childhood Illness in Management of Acute Respiratory Infection in an Urban Maternal and Child Health Center-Egypt

HUBUNGAN TRADISI PENGHANGATAN ARANG DAN KONDISI FISIK RUMAH DENGAN KEJADIAN ISPA PADA IBU NIFAS DI DESA BERAMPU KECAMATAN BERAMPU KABUPATEN DAIRI TAHUN 2020

Charcoal warming tradition is believed to help the recovery process in postpartum mothers. The purpose of this study was to determine the relationship between charcoal warming traditions and physical conditions of the house with the incidence of acute respiratory infections in postpartum mothers. The method of reseaech used the analytic case control approach. The population of this research was 50 mothers who had history of acute respiratory infections in Berampu village and the control sample was 50 people. The technique of the sample of this research is probability sampling.The Statistical analysis used bivariate analysis with chi square test and multivariate analysis with logistic regression test. The results of the bivariate analysis showed a relationship between the Charcoal Warming Tradition, p value = 0.002, between maternal parity, p value = 0.043, between the physical conditions of the house, p = 0.027, and the incidence of acute respiratory infections. The results of the multivariate analysis show that there is an influence between the Charcoal Warming Tradition (Exp B: 3,626), Mother Parity (Exp B: 2,517) and the Physical Condition of the House (Exp B: 2,354) on the incidence of acute respiratory infections in post- partum mothers in Berampu Village, District, Dairi Regency in 2020 The Suggestions for researchers Furthermore, this research is used as reference material regarding acute respiratory infections in order to carry out the proper management of acute respiratory infections. or Respondents to replace the warming tradition by using blankets. For public health center Developing health promotion for postpartum education.

Therapeutic management of acute respiratory infections in AIEPI

To determine the therapeutic management of acute respiratory infections within the IMCI strategy in children from 2 to 59 months in the health centres of Déleg, Javier Loyola and San Miguel de Porotos. Materials and Methods: Descriptive study, cross-sectional, quantitative, sample of 314 children attended in the health center Déleg, Javier Loyola and San Miguel de Porotos, diagnosed with acute respiratory infection. Instrument: A collection form was designed with the respective validation by experts. Data were collected from the medical history of children from 2 to 59 months. Results: Male predominance 56.7%, age 2 to 11 months 28.6%, predominance of cough or common cold 31.4% followed by pharyngo-tonsillitis 22.2%, therapeutic management of pharyngo-tonsillitis is based on the use of amoxicillin and paracetamol 54.5%, in cough or cold receive paracetamol 30.8% and other children with the same diagnosis receive paracetamol plus loratadine 72%. In simple counseling, sore throat relief predominates 80.0% and cough relief 65%. Conclusion: The classification specified in the IMCI strategy is not met. There is a high percentage of diagnoses of pharyngo-tonsillitis that are not specified as being viral or bacterial, and other cases are treated with amoxicillin plus clavulanic acid.

1. ReKOMendacje Postępowania w ostrych zakażeniach dróg oddechowych u dzieci w czasie pandemii SARS-CoV-2 dla lekarzy Podstawowej Opieki Zdrowotnej – KOMPAS COVID

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kuchar E, Karlikowska-Skwarnik M, Szenborn L, Jackowska T, Doniec Z, Mastalerz-Migas A. Recommendations for primary healthcare doctors for the management of acute respiratory infections in children during the SARS-CoV-2 pandemic – COVID COMPASS. Family Medicine & Primary Care Review. 2021;23(1):116-124. doi:10.5114/fmpcr.2021.102647. APA Kuchar, E., Karlikowska-Skwarnik, M., Szenborn, L., Jackowska, T., Doniec, Z., & Mastalerz-Migas, A. (2021). Recommendations for primary healthcare doctors for the management of acute respiratory infections in children during the SARS-CoV-2 pandemic – COVID COMPASS. Family Medicine & Primary Care Review, 23(1), 116-124. https://doi.org/10.5114/fmpcr.2021.102647 Chicago Kuchar, Ernest, Monika Karlikowska-Skwarnik, Leszek Szenborn, Teresa Jackowska, Zbigniew Doniec, and Agnieszka Mastalerz-Migas. 2021. "Recommendations for primary healthcare doctors for the management of acute respiratory infections in children during the SARS-CoV-2 pandemic – COVID COMPASS". Family Medicine & Primary Care Review 23 (1): 116-124. doi:10.5114/fmpcr.2021.102647. Harvard Kuchar, E., Karlikowska-Skwarnik, M., Szenborn, L., Jackowska, T., Doniec, Z., and Mastalerz-Migas, A. (2021). Recommendations for primary healthcare doctors for the management of acute respiratory infections in children during the SARS-CoV-2 pandemic – COVID COMPASS. Family Medicine & Primary Care Review, 23(1), pp.116-124. https://doi.org/10.5114/fmpcr.2021.102647 MLA Kuchar, Ernest et al. "Recommendations for primary healthcare doctors for the management of acute respiratory infections in children during the SARS-CoV-2 pandemic – COVID COMPASS." Family Medicine & Primary Care Review, vol. 23, no. 1, 2021, pp. 116-124. doi:10.5114/fmpcr.2021.102647. Vancouver Kuchar E, Karlikowska-Skwarnik M, Szenborn L, Jackowska T, Doniec Z, Mastalerz-Migas A. Recommendations for primary healthcare doctors for the management of acute respiratory infections in children during the SARS-CoV-2 pandemic – COVID COMPASS. Family Medicine & Primary Care Review. 2021;23(1):116-124. doi:10.5114/fmpcr.2021.102647.

Increased Return Clinic Visits for Adults with Group A Streptococcal Pharyngitis Treated with a Macrolide

Background: A multicenter audit-and-feedback intervention was conducted to improve management of acute respiratory infections (ARIs) including group A streptococcal (GAS) pharyngitis within 6 VA medical Centers (VAMCs). A relative reduction (24.8%) in azithromycin prescribing after the intervention was observed. Within these facilities during 2015–2018, 2,266 cases of GAS occurred, and susceptibility to erythromycin ranged from 55% to 70%. We evaluated whether prescribing a macrolide for GAS pharyngitis was associated with an increase in outpatient return visits. Methods: A cohort of ambulatory adults treated for GAS pharyngitis (years 2014–2019) at 6 VAMCs was created. Demographic, diagnostic, treatment, and revisit data were extracted from the Corporate Data Warehouse. GAS pharyngitis was defined by an acute pharyngitis diagnostic code combined with a GAS-positive rapid strep test or throat culture ≤3 days of index date. Antibiotic prescriptions were included if filled ≤3 days of index date and were classified as first line (penicillin/amoxicillin), second line (cephalexin/clindamycin), macrolides (azithromycin, clarithromycin, erythromycin), or other (remaining antibiotics). A return visit was defined as a new visit to primary care, urgent care, or the emergency department with a diagnostic code for an ARI ≤30 days from the index visit. Logistic regression was used to adjust for nonantibiotic covariates and to compare treatments. Results are reported as odds ratio (OR ± 95% CI; P value). Results: Of 12,666 patients with a diagnostic code for acute pharyngitis, 2,923 (23.1%) had GAS testing performed. Of those, 582 (19.9%) were GAS-positive and 460 (15.7%) received antibiotics. The mean age was 39.0 years (±SD, 11.7) and 73.7% were male. Antibiotics included penicillins for 363 patients (78.9%), cephalosporins for 21 (4.6%), clindamycin for 32 (7.0%), macrolides for 47 (10.2%), and other for 17 (3.9%). Penicillin allergy was documented in 48 patients (10.5%), and these patients received cephalosporins (18.8%), clindamycin (35.4%), macrolides (41.7%), and other antibiotics (4.2%). Return visits occurred in 47 cases (10.4%). Limited chart review indicated that 6 of 10 macrolide recipients (60.0%) with return visits had recurrence or unresolved symptoms. After adjustment for calendar month and facility, odds of a return visit for treatment with a macrolide relative to penicillins was 2.79 (OR, 1.19; 95% CI, ±6.56; P = .02). The audit-feedback intervention was not associated with ARI-related return visits (OR, 0.53; 95% CI, 0.26–1.06; P = .07). Conclusions: Return visit rates were higher for GAS pharyngitis patients treated with a macrolide than for those treated with penicillins. Macrolides were the most commonly prescribed non-penicillin therapy irrespective of penicillin allergy. Further work is necessary to determine the reason for the increase in return visits.Funding: NoneDisclosures: None