Prophylactic Antibiotics In Children Research Articles

ADHERENCE TO THE USE OF PROPHYLATIC PENICILLIN AND ASSOCIATED COSTS IN SICKLE CELL DISEASE

Sickle cell disease (SCD) is the most prevalent hemoglobinopathy in the world with a lethality of 3.4%. The main cause of death in this population is related to infectious conditions. Infection control in children with SCD depends on early diagnosis, an extended vaccination card and regular prophylactic use of penicillin, however, the low rate of adherence to antibiotic prophylaxis is a common problem in clinics. to assess the adherence to antibiotic prophylaxis and to describe the cost of prophylactic antibiotics in children with SCD. Cross-sectional study of 126 children born between 1998 and 2007 with SCD. Adherence was assessed through structured interviews with caregivers, review of medical records and the data were correlated with the socioeconomic profile of the main caregiver. To measure costs the dosage and periodicity of the drugs followed the Clinical Protocol and Therapeutic Guidelines for SCD. The price of phenoxymethylpenicillin was extracted from the Price Bank of the Regulation Chamber of the Medicines Market. Of the 115 patients included, 50.4% were male. The analysis of the questionnaire revealed that the mother was the main responsible for the answers (83.5%) and the main caregiver who administered the medication (86.1%). Maximum adherence, defined as no absence of administration and regular hours, was 45.2%. The family income of 37.4% of respondents was less than the minimum wage. There was no statistically significant association between the adherence rate and the variables: gender, family income and education of caregivers. The total real cost of the sample with phenoxymethylpenicillin was US $ 102,824.50. Considering only those who had maximum membership (45.2%) this amount was US $ 47,922.65. Adherence to prophylactic antibiotic therapy was low and actions are needed to increase the use of penicillin, which is not a high-cost medication. Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) APQ-01513-10, Fundação Hemominas and National Institute of Health. Number ID Grant HHSN26822011000071 (REDSIII).

The additive impact of the distal ureteral diameter ratio in predicting early breakthrough urinary tract infections in children with vesicoureteral reflux

Many factors influence patient and provider decisions to surgically correct vesicoureteral reflux (VUR), including risk of breakthrough febrile urinary tract infections and likelihood of spontaneous resolution. Ureteral diameter ratio has been shown in several studies to be more predictive than reflux grade with regard to breakthrough urinary tract infection (UTI). We developed and investigated the accuracy of a computational model for predicating febrile breakthrough urinary tract infection within 13 months of starting prophylactic antibiotics in children with VUR. The aim of this study was to validate a model for evaluating the impact of distal ureteral diameter ratio (UDR) in predicting early breakthrough urinary tract infections in children with VUR. Following a retrospective review, we recorded patient demographics, presenting symptoms, VUR grade, laterality, VUR during filling or voiding, initial bladder volume at the onset of VUR, ureteral duplication, voiding dysfunction, distal ureteral diameter ratio, and number of UTIs prior to VUR diagnosis. NeUROn++, a set of C++ programs, was used to model each data set using logistic regression and neural networks with different architectures. After exclusions, 136 children (93 girls and 43 boys) diagnosed with primary VUR had detailed VCUG and UDR data available. Fourteen children (10.3%) experienced breakthrough febrile UTI events within 13 months of VUR diagnosis. There was a significant association with UDR and breakthrough UTI (p=0.008). Various computational prediction models for the outcome of breakthrough UTI were developed and evaluated. The computational model that fit best was a model using all variables with an ROC of 0.802. Clinicians and parents often opt for intervention based on likelihood of spontaneous resolution of VUR as well as clinical course, thereby placing an emphasis on the ability to predict likelihood of breakthrough UTI infections. Our statistical analysis and prediction models further confirm UDR as an important variable predictive of breakthrough UTIs within the first 13 months of beginning prophylactic antibiotics. Furthermore, we developed a neural network model incorporating UDR and grade with an ability to yield the greatest accuracy of any breakthrough UTI predictive calculator to date at 80%.

Susceptibility of the Index Urinary Tract Infection to Prophylactic Antibiotics Is a Predictive Factor of Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux Receiving Continuous Antibiotic Prophylaxis.

BackgroundFew studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP.MethodsWe retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI.ResultsOf the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (P = 0.037). Progression of renal scarring was observed in 0% of children in the susceptible group and 15% in the resistant group (P = 0.053). Multivariate analysis showed that TMP-SMX resistance and initial renal scarring were significant predictors of breakthrough UTI.ConclusionSusceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.

Compliance with perioperative prophylaxis guidelines and the use of novel outcome measures.

Postoperative wound infections represent an important source of morbidity and mortality in children. Perioperative antibiotic prophylaxis has been shown to decrease the risk of developing infections and hospital guidelines surrounding antibiotic use exist to standardize patient care. Despite supporting evidence, rates of compliance with guidelines vary. Quality improvement initiatives have been introduced to improve compliance with intraoperative antibiotic guidelines. Thorough infection surveillance, including antibiotic provision in presurgical checklists, computerized voice antibiotic administration prompts, and national feedback systems are now increasingly common. Few studies have been conducted investigating the effectiveness of prophylactic antibiotics in children. Outcome measures such as morbidity and mortality and return to the operating room can be used to examine the relationship between antibiotic use and patient outcome but these measures are limited in that they occur infrequently or are subjective and difficult to measure. Metrics such as days alive out of hospital and length of hospital stay may be useful alternatives for ongoing monitoring of infections and identifying improvements in patient outcomes. Guidelines on antibiotic prophylaxis have facilitated an increase in the correct provision of perioperative antibiotics and a reduction in the incidence of postoperative infection. Measures of patient outcome such as days alive out of hospital and length of hospital stay are easy to collect and calculate but further work is needed to confirm the utility of these measures for monitoring infection rates.

Elevation of Temperature after General Anaesthesia following Dental Treatment with or without the use of Prophylactic Antibiotics in Children

AIM: To study the elevation of temperature after general anaesthesia following dental treatment with or without the use of prophylactic antibiotics in children. INTRODUCTION: General anaesthesia is a choice in pediatric patients who are uncooperative, physically or mentally compromised. Bacteremia is a common consequence following dental treatment and as a result elevation of temperature. Bacteraemia can occur following general anaesthesia through nasotracheal intubation. Antibiotic prophylaxis prior to general anaesthesia can prevent hyperthermia. MATERIALS AND METHODS: Paediatric patients in the age group of 2-6 years. were included in this study under general anaesthesia due to uncooperative behaviour or due to medical complications. Antibiotics was administered to one group one hour prior to the treatment and not administered to the other. Preoperative and post operative temperatures were recorded. RESULTS: Out of eighty three pediatric patients in the age group 2-6 years who participated in this study, thirty five patients (42.1%) presented with elevation in temperature (temperature exceeding 98 degree Fahrenheit). Significant difference in temperature was found between those who were administered antibiotics and in those who were not. Post operative increase in temperature was found in seventeen out of forty girls (42.5%) and in eighteen out of forty three boys (41.8%) CONCLUSION: This study showed that there is a relation between bacteremia and post operative increase in temperature. Post operative increase in temperature was less in those who were administered antibiotics prior to GA than in those who were not administered.

Prophylactic antibiotics for children with recurrent urinary tract infections

Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. A large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community-acquired urinary tract infections. The results of three recent significant studies are examined, with focus on the efficacy of prophylaxis, and recommendations are made.

Controversy in Urinary Tract Infection Management in Children: A Review of New Data and Subsequent Changes in Guidelines

Controversy and lack of consensus have been encountered in the management of pediatric urinary tract infection (UTI), including its diagnosis, radiological investigations and the use of antibiotic therapy. In this review, we discuss the need for radiological investigations and the extent of their use as well as the need for prophylactic antibiotics in children with UTI and vesicoureteral reflux. Only a small proportion of children with first UTI and no history of antenatal renal abnormalities have clinically important malformations. Renal ultrasound should be performed in febrile infants and young children with UTI; a micturating cystourethrogram should not be performed routinely after the first febrile UTI. Long-term antibiotics appear to reduce the risk of recurrent symptomatic UTI in susceptible children, although the clinical benefit is marginal. Current recommendations encourage performing radiological investigations only in children at risk and discourage routine prophylactic antibiotic use.

Limited Evidence for Prophylactic Antibiotics for Children With Recurrent Urinary Tract Infections

Limited Evidence for Prophylactic Antibiotics for Children With Recurrent Urinary Tract Infections

Antibiotic prophylaxis for children at risk of developing urinary tract infection: a systematic review

Antibiotic prophylaxis in children who have had urinary tract infection (UTI) to prevent further infection is a common practice. The aim of this study is to reduce the development of further renal scarring by the prevention of recurrent acute pyelonephritis. A systematic review of randomized controlled trials assessing effectiveness of antibiotic prophylaxis in children who have recovered from a symptomatic UTI and children in whom vesico-ureteric reflux has been identified independent of a history of acute UTI was carried out by systematic search in Medline, EMBASE, the Cochrane Library and CINAHL using keywords and thesaurus terms. Identified trials were independently appraised by two researchers. Data were extracted and synthesized in meta-analyses. A total of 677 children in eight trials were included in the analyses. There was no evidence of difference on meta-analysis of all the included studies, or any of the four subgroups, between the intervention and control groups in recurrence of symptomatic UTI [four trials, RR 0.96 (95% CI: 0.69-1.32]) and incidence of new or progressive renal scarring [four trials, overall RR 1.15 (95% CI: 0.75-1.78)]. Given the lack of evidence on positive benefit of using prophylactic antibiotics for children at risk of developing UTI, routine use of antibiotics for these children is not recommended.

What good or harm comes from prophylactic antibiotics in children with vesicoureteral reflux?

What good or harm comes from prophylactic antibiotics in children with vesicoureteral reflux?

CAN PROPHYLACTIC ANTIBIOTICS SAFELY BE DISCONTINUED IN CHILDREN WITH VESICOURETERAL REFLUX?

We review the outcome of stopping prophylactic antibiotics in children with persistent vesicoureteral reflux (VUR). We performed a retrospective chart review of patients with VUR followed off antibiotics during the last 12 years. Selection criteria included children 4 years old or older who were toilet trained, could verbalize and had a normal voiding pattern. Exclusion criteria were posterior urethral valves, ectopic ureter, neurogenic bladder and severe voiding dysfunction. Outcome measures were age at stopping antibiotics, duration on and off antibiotics, grade of reflux at the time of stopping antibiotics, the occurrence of urinary tract infections (UTI) and new renal scarring on followup. All patients had upper tract assessment performed with renal ultrasound. A total of 67 girls (85.9%) and 11 boys (14.1%) were included in the analysis. VUR was bilateral in 36 patients (46.2%), on the left side in 29 (37.2%) and on the right side in 13 (16.7%). Reflux was grade I in 16.7% of the cases, II in 75.6% and III in 7.7%. Mean patient age when taken off antibiotics was 5.74 years. The period on prophylactic antibiotics ranged from 0 to 84 months (mean 26.2) and the period off antibiotics ranged from 5 to 138 months (37.7). UTI developed in 9 girls (11.5%), of whom 8 had cystitis (10.2%) and 1 had clinically presumptive pyelonephritis (1.3%). These 9 girls were off antibiotics 5 to 60 months (mean 21.1). None of our patients, including those with UTI, had new renal scarring on followup renal ultrasound. Discontinuing prophylactic antibiotics in selected school age children is safe practice. The risk of significant upper tract infection is low and the development of new renal scars unlikely. However, we fully acknowledge that renal ultrasound is not the most accurate investigation for detection of renal scars. Therefore, continuing medical surveillance of these children is important.

Prophylactic antibiotics in children at risk for urinary tract infection

The outcome of using prophylactic antibiotics in children considered at risk for a urinary tract infection (UTI) was documented in 66 children during the period of suppressive antibiotics and for a follow-up period of 3.7+/-2.2 years (range 0.92-9.83 years). A breakthrough UTI occurred in 13 girls but none of the boys during the initial course of prophylactic antibiotics. During the follow-up period, 33 girls and 5 boys had no recurrence of infection, while 25 girls and 3 boys had UTIs. Statistical analysis of the data using chi-square and risk estimate relating factors for infection to the occurrence of a UTI showed that during the period of initial prophylactic antibiotic there was significant risk of infection among children with voiding dysfunction and abnormal kidneys and during the follow-up there was increased risk of infection among those with voiding dysfunction and vesicoureteric reflux (VUR) of grade 3 or greater severity. Lesser grades of VUR and constipation did not significantly increase the risk of UTI. These observations should be useful in developing a study to define the risks and benefits of prophylactic antibiotic in "at-risk" children.

CESSATION OF PROPHYLACTIC ANTIBIOTICS FOR MANAGING PERSISTENT VESICOURETERAL REFLUX

We reviewed our experience with patients with vesicoureteral reflux treated off prophylactic antibiotics. We retrospectively reviewed the records of patients with vesicoureteral reflux treated off prophylactic antibiotics, noting the intervals on and off antibiotics, urinary tract infection, signs and symptoms associated with urinary tract infection, and renal ultrasound and dimercapto-succinic acid scan findings. We identified 196 patients with vesicoureteral reflux treated off prophylactic antibiotics, including 122 who were infection-free while on and 124 who had no urinary tract infection while off prophylactic antibiotics. The infection rate on and off prophylactics was 0.29 and 0.24 urinary tract infections per patient per year, respectively. New scars were identified in 5 patients while on prophylactics and in 7 after antibiotics were discontinued. Comparing different subgroups off prophylactic antibiotics showed that children who presented with scarring had statistically fewer new scars than those with normal initial dimercapto-succinic acid imaging (p <0.043). Girls had significantly more urinary tract infections than boys while off prophylactics (p <0.01) despite the older age at antibiotic cessation. However, after infection occurred while off prophylactic antibiotics, new renal scars developed at about the same rate in boys and girls. Because most patients did not have a urinary tract infection while off prophylactic antibiotics, new renal scars developed in only 2.2% of all boys and 4% of all girls. Our findings imply that discontinuing antibiotics is reasonable and safe in patients in whom vesicoureteral reflux fails to resolve.

THE OUTCOME OF STOPPING PROPHYLACTIC ANTIBIOTICS IN OLDER CHILDREN WITH VESICOURETERAL REFLUX

Accepted management of vesicoureteral reflux includes surgical correction or prophylactic antibiotics with the hope for resolution as the child grows. The physician must consider surgery when reflux does not resolve despite uneventful years on prophylactic antibiotics. An alternative is cessation of the antibiotics. We report on the outcome of children taken off antibiotics with persistent reflux. During a 14-year period 51 children with documented reflux were taken off antibiotic prophylaxis. Selection criteria included children who were old enough to verbalize the symptoms of a urinary tract infection, and had normal voiding patterns, a minor history of infections and minimal or no renal scarring. Routine followup included nuclear cystography and renal sonography. A total of 40 girls and 11 boys maintained on antibiotics for a mean of 4.8 years were taken off prophylaxis and followed for an average of 3.7 years. Mean patient age when prophylactic antibiotics were stopped was 8.6 years. Reflux resolved in 10 children (19.6%). A urinary tract infection developed in 5 girls and 1 boy (11.8%) (mean age 11) an average of 2.3 years (range 4 months to 9.4 years) after antibiotic discontinuation. One child had symptoms consistent with cystitis and 5 had febrile urinary tract infections. All were treated with oral antibiotics and 5 had subsequent operations. No new renal scars developed. The majority of children did well following cessation of antibiotic prophylaxis despite persistent vesicoureteral reflux. Cessation of antibiotic prophylaxis is a reasonable option in a highly select patient population with reflux.

Prophylactic antibiotics in children

Prophylactic antibiotics in children

Prophylactic antibiotics for children with measles seem to have little effect on mortality

Prophylactic antibiotics for children with measles seem to have little effect on mortality

Use of trimethoprim-sulfamethoxazole to prevent bacterial infections in children with acute lymphoblastic leukemia

We assessed the efficacy of prophylactic antibiotics in children receiving intensive chemotherapy for acute lymphoblastic leukemia. The patients were randomized to receive either trimethoprim-sulfamethoxazole (TMP-SMX) or placebo in a double-blind trial. Thirty patients were evaluated in each group. Children receiving TMP-SMX had fewer episodes of bacteremia (0 vs. 5) and otitis media (3 vs. 18). The geometric mean of the neutrophil nadir was 172 in the TMP-SMX group and 287 in controls. However, no increased delay or dose reduction of chemotherapy was observed in the TMP-SMX treated patients. Five patients who received TMP-SMX developed Gram-negative rods resistant to TMP-SMX on surveillance stool cultures. We conclude that TMP-SMX prophylaxis decreased certain bacterial infections in children with acute lymphoblastic leukemia without causing clinically significant toxicity. The emergence of Gram-negative rods resistant to TMP-SMX in treated patients suggests that TMP-SMX prophylaxis should be restricted to patients who are at high risk for developing a bacterial infection or Pneumocystis carinii pneumonia.

PROCEEDINGS OF THE AUSTRALASIAN SOCIETY OF CLINICAL AND EXPERIMENTAL PHARMACOLOGISTS

PROCEEDINGS OF THE AUSTRALASIAN SOCIETY OF CLINICAL AND EXPERIMENTAL PHARMACOLOGISTS

Prophylactic antibiotics in children.

Prophylactic antibiotics in children.

The use of prophylactic systemic antibiotics in compound depressed skull fractures in infancy and childhood

The authors described their experience with the use of prophylactic antibiotics in children with compound depressed skull fractures. The analysis of the results of the treatment of patients with or without systemic antibiotics and with or without the replacement of the bone fragments showed no difference in the infection rate, any one was the method used.