Rate Of Multidrug-resistant Bacteria Research Articles

Increase in Incidence Rates and Risk Factors for Multidrug Resistant Bacteria in Septic Children: A Nationwide Spanish Cohort Study (2013-2019).

The emergence of multidrug-resistant (MDR) bacteria in children is a growing concern, particularly among septic patients, given the need for first-right dosing. Our aim was to determine the incidence rates and factors associated with MDR-sepsis in the pediatric intensive care unit (PICU), using data from the Spanish ENVIN-HELICS PICU registry between 2013 and 2019. The rate of MDR bacteria among septic children ranged between 5.8 and 16.2% throughout this study period, with a significant increase since 2015 (p = 0.013). MDR-gram-negative bacteria (92%), particularly EBL-Enterobacterales (63.7%), were the most frequent causative microorganisms of MDR-sepsis. During this study period, sixteen MDR-sepsis (32.6%) corresponded to intrahospital infections, and 33 (67.4%) had community-onset sepsis, accounting for 10.5% of the overall community-onset sepsis. Independent risk factors associated with MDR-sepsis were antibiotics 48 h prior to PICU admission (OR 2.38) and PICU onset of sepsis (OR 2.58) in >1 year-old children, and previous malnourishment (OR 4.99) in <1 year-old children. Conclusions: There was an alarming increase in MDR among septic children in Spain, mainly by gram-negative (ESBL-Enterobacterales), mostly coming from the community setting. Malnourished infants and children on antibiotics 48 h prior to PICU are at increased risk and therefore require closer surveillance.

Isolation and Detection of Drug-Resistant Bacterial Pathogens in Postoperative Wound Infections at a Tertiary Care Hospital in Saudi Arabia.

Surgical site infections (SSIs), especially when caused by multidrug-resistant (MDR) bacteria, are a major healthcare concern worldwide. For optimal treatment and prevention of antimicrobial resistance, it is important for clinicians to be aware of local drug-resistant bacterial pathogens that cause SSIs. To determine the frequency patterns of drug-resistant bacterial strains causing SSIs at a tertiary care hospital in Saudi Arabia. This retrospective study was conducted at the Microbiology laboratory of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, and included wound swab samples from all cases of SSI between January 01, 2017, and December 31, 2021. The swabs were processed for the identification of bacterial strains and their resistance pattern to antibiotics according to the Clinical and Laboratory Standards Institute. A total of 5409 wound swabs were analyzed, of which 3604 samples (66.6%) were from male. Most samples were from the Department of Surgery (43.3%). A total of 14 bacterial strains were isolated, of which 9 were Gram-negative bacteria. The most common isolates were Klebsiella pneumoniae, followed by Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and vancomycin-resistant S. aureus (VRSA). In terms of MDR in 2021, the highest rate of carbapenem-resistance was in A. baumannii (97%). MDR was as follows: A. baumannii, 97%; K. pneumoniae, 81%; E. coli, 71%; MRSA, 60%; P. aeruginosa, 33%; VRE, 22%; and VRSA, 2%. This study showed that in the city of Makkah, Saudi Arabia, the rates of MDR bacteria are high, with the majority being Gram-negative.

Antibiogram Pattern of Multidrug Resistance of Gram-negative Extended Betalactamase Isolates from Urine of Diabetic Patients

Background: The rate of multidrug resistant bacteria is the most worrisome in the health setting because it often associates with nosocomial infection. Objectives: This present study aim at, evaluating the antibiotic pattern of multidrug resistance of Gram-negative extended betalactamase isolates from urine of diabetic patients. Methods: This is a cross sectional study carried out at Nnamdi Azikiwe University Teaching Hospital with a total of 110 diabetic patients and were recruited using convenient sample method. The patients were instructed on how to collect the mid-stream urine samples without contamination. The samples were cultured and characterized the isolates following standard bacteriological methods. The isolated bacteria were subjected to sensitivity test pattern using agar disc diffusion techniques. The multidrug resistant isolates were physically checked for the extended spectrum betalactamase production. Obtained data was subjected to these statistical tools; descriptive statistics, chi-square and pair-test using Statistical Package for the Social Science (SPSS version 26). Results: Out of 110 urine samples assessed for significant growth of bacteria, it was found that, 55(27%) were the Gram negative bacteria (GNB).The highest prevalence of isolates were E. coli 30(54.6%), followed by Klebsiella pneumonia 14 (25.5%), Pseudomonas aeruginosa 6 (10.9%), and Proteus species 5 (9.09%) respectively. The most occurrence of the MDR bacteria were found in Augmentin 46 (83.6%) as well as as Cefuroxime 43 (78.2%) respectively. The significant mean range of Augumentin and Cefixime resistant to ESBL producers were (0.53±1.2; p = 0.000) and (0.600 ± 0.974; p = 000) respectively. Conclusion: The study detected the high proportion of multi-drug resistant isolates and the most occurrence were found in E. coli and Klebsiella pneumoniae. Regular monitoring, conducting, supervising, or management of antibiotics and molecular biomarkers for drug resistance are paramount to curtail the rate of drug-resistant pathogens.

Antibiotic Use in Patients Undergoing Complex Clean-Contaminated Head and Neck Surgery: A Prospective Study.

Oncological surgery of the upper aerodigestive tract is a complex procedure and often includes neck dissection and flap reconstruction. It can be complicated by severe surgical site infection (SSI) leading to flap necrosis, delayed wound healing, and increasing mortality and morbidity. The purpose of this study is to perform a systematic descriptive analysis and to evaluate the effect of our adapted antibiotic regimen strategy on postoperative outcomes. A prospective cohort analysis of 47 patients undergoing major clean-contaminated head and neck surgery was conducted at the Cervicomaxillofacial Surgery Department (Saint-Pierre Hospital), between 2019 and 2022. The patients were divided into two groups: group I, which received a short-term postoperative antibiotic regimen for 24 h, and group II, which received a more extended postoperative antibiotic course for more than 24 h. Antibioprophylaxy amoxicillin and clavulanate were administered intravenously 30-60 min before making the incision. The antibiotic regimen was continued after surgery. The prognostic significance of the antibiotic regimen on postoperative outcomes, including clinical signs of infection and biological markers such as white blood cells count, and C-reactive protein levels was evaluated using univariate analysis. Eighteen patients developed SSIs. All of these infections were grade 2 and were treated with antibiotics. After univariate analysis, only a history of hypothyroidism seems to be a predictor of SSI (P = 0.038). No significant difference was found in terms of onset and hospital stay when we compared the patients who received antibiotics for 24 h or more. Moreover, the rate of multidrug-resistant bacteria was not different in both groups. Our results suggest that postoperative antibiotics for more than 24 h do not confer benefit in terms of SSI. Oncological patients undergoing complex clean-contaminated head and neck surgery are often suffering from infectious complications and, despite the absence of guidelines, practicians should consider these findings in their decision-making.

Bacterial Isolates from Urinary Tract Infection in Dogs and Cats in Portugal, and Their Antibiotic Susceptibility Pattern: A Retrospective Study of 5 Years (2017-2021).

There are growing concerns regarding the rise of antimicrobial-resistant bacteria in companion animals. This study aimed to bring new insights into the current scenario of Portugal's antimicrobial resistance bacteria isolated from companion animals with urinary tract infections and is the first to be performed during a long period on a large scale. Of a total of 17472 urine samples analyzed, 12,166 (69.6%) (CI 12,200-12,200) were negative for bacterial growth, and 5306 (30.4%) (95% CI 5310-5310) had bacterial growth. Of the culture-positive samples, 5224 (96.6%) (95% CI 5220-5220) were pure cultures and 82 (3.2%) (95% CI 81.9-82.1) had mixed growth. Escherichia coli was the most frequently isolated bacteria (n=2360, 44.5%) (95% CI 2360-2360), followed by Proteus mirabilis (n=585, 11%) (95% CI 583-583), Enterococcus faecium (n=277, 5.2%) (95% CI 277-277) and Staphylococcus pseudintermedius (n=226, 4.3%) (95% CI 226-226). The overall susceptibility rates were low for erythromycin (45.3%) and clindamycin (51.3%), and high for aminoglycosides (96.3%), carbapenems (92.4%), trimethoprim-sulfamethoxazole (81.2%), and quinolones (79.9%). E. coli also showed considerable resistance to amoxicillin-clavulanic acid. The rates of multidrug-resistant bacteria are still high compared to the northern countries of Europe. This study's findings show the emergence of antibiotic resistance in the antibiotic agents commonly used in the treatment of UTIs in dogs and cats in Portugal.

Multiplex PCR: A Molecular Modality for Rapid Detection of CTX-M-15, AAD A1 and QNR S1 Genes among Drug Resistant Clinical Isolates of Enterobacteriaceae in Kanchipuram, South India

Multidrug resistance is a potential threat to the mankind. The prevalence rate of multidrug resistant bacteria is worrisome and has gained significant attention globally. Hence it becomes imperative for clinical laboratories to identify these multidrug resistant pathogens for appropriate therapy. It is equally important to detect the resistance mechanisms which would aid in understanding and development of new therapeutic options. This study was carried out to identify the prevalence of multidrug resistant Enterobacteriaceae from clinical samples recovered from Kanchipuram district. The study was also implicated in designing of novel primers using primer3 tool and standardizing a multiplex PCR targeting ctxm- 15, aadA1, qnrS1 genes in the isolates. Of the 60 clinical isolates studied, 14, 13 and 12 isolates harbored ctx-m-15, qnrS1 gene and aadA1genes respectively. Among these, 2 isolates carried both ctx-m-15 and qnrS1 genes and 3 isolates were found to carry both ctx-m-15 and aadA1 genes. 1 isolate was found to be positive for both aadA1 and qnrS1 genes. None of these isolates harbored all the three targeted genes qnrS1 and aadA1, ctx-m-15. The present study will aid in detecting drug resistant genes like ctx-m-15, aadA1, qnrS1 in clinical isolates with higher sensitivity and specificity and will also reduce the cost of reaction than that required for uniplex PCR. The prevalence rate of drug resistant genes among Kanchipuram district alerts us for the measures needed to be undertaken to control the spread of drug resistant genes in community.

C. auris and non-C. auris candidemia in hospitalized adult and pediatric COVID-19 patients; single center data from Pakistan

26 candidemia cases (4 Candida auris;22 non-C. auris) in COVID-19 patients (April-December 2020) are reported from Pakistan. Compared to non-C. auris, C. auris candidemia patients had higher prior antifungal exposure, longer hospital stay, higher rates of MDR bacteria and Candida colonization.

Susceptibility of multidrug-resistant nosocomial pathogens for the new antimicrobial agents in Jordan

Background&#x0D; To study resistance rates of multidrug-resistant bacteria (MDR) for new Cephalosporines before their widespread use in Jordan.&#x0D; Methods&#x0D; During September 2019 - May 2020, MDR-bacteria were prospectively collected from microbiology laboratories of three hospitals, susceptibility of the extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL), K. pneumoniae-carbapenemases strains (KPC), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CRPa), carbapenem-resistant A. baumannii (CRAb), and Methicillin-resistant Staphylococcus aureus (MRSA) were tested. Demographic details for patients were identified. Antimicrobials evaluated were ceftazidime-avibactam, ceftolozane-tazobactam, and ceftobiprole medocaril.&#x0D; Results&#x0D; Non-duplicate 263 MDR clinical isolates were collected from sterile sites; ESBL (128), P. aeruginosa (57), MRSA (37), KPC (22), A. baumannii (11), and CRE (n = 8). The age was dominated by the older age group (Age &gt; 64, Pearson R = 0.985, R2 = 0.969, P = 0.000). Males were 143 and females 107 (P &lt; 0.000). There were (194) isolate from the wards and (55) were from the ICUs. Sources were urine (96), blood (36), soft tissues (49), abdomen (24), URT (14), and osteo-skeletal (12). Clinical diagnoses were: UTI (90). Bacteremia (36), SSTI (45), IAI (23), pneumonia (17), URTI (13), osteomyelitis (11), and diabetic foot (6). The susceptibility of the ESBL-producing bacteria was 100% for meropenem, 99% for ceftazidime-avibactam, and 90% for ceftolozane/tazobactam. P. aeruginosa was, 73% for ceftazidime-avibactam, 62% susceptible to ceftolozane/tazobactam, 62% for meropenem, and 45% to ceftobiprole. CRE was 38% susceptible to ceftazidime-avibactam and KPC 15%, while ceftolozane-tazobactam susceptibility was zero, and 14% for CRE, and 0% for Ceftobiprole Medocaril. A. baumannii was 13% susceptible to ceftazidime-avibactam, meropenem 9%, and 2% for ceftolozane/tazobactam&#x0D; Conclusion&#x0D; Ceftazidime-avibactam and ceftolozane/tazobactam may be useful alternatives for the treatment of ESBL-producers and P. aeruginosa, though the MDR-bacteria demonstrated some resistance to the newly introduced agents before their widespread use in the country.&#x0D;

Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Benin

BackgroundSurgical site infections are related to high morbidity, mortality and healthcare costs. Because the emergence of multidrug-resistant bacteria in hospitals is becoming a worldwide challenge for surgeons who treat healthcare-associated infections, we wished to identify the causative agents involved in these infections and the rate of multidrug-resistant bacteria in six public hospitals in Benin.MethodsUsing standard microbiological procedures, we processed pus specimens collected from obstetrics and gastrointestinal surgery wards. Mass spectrometry (MALDI-TOF) was used for confirmation. For the antibiotic susceptibility test, we first used the Kirby-Bauer disk diffusion method. The secondary test (by microdilution) used the Beckton Dickinson Phoenix automated system (Becton Dickinson Diagnostic, USA).ResultsWe included 304 patients, whose median length of stay was 9 days. A total of 259 wound swabs (85.2%) had positive aerobic bacterial growth. In obstetrics, S. aureus (28.5%, n = 42) was the most common isolate. In contrast, Gram-negative bacteria (GNB) were predominant in gastrointestinal surgery, the most dominant being E.coli (38.4%, n = 31). Overall, 90.8% (n = 208) of aerobic bacteria were multidrug resistant. Two-thirds of S. aureus (65.3%, n = 32) were methicillin-resistant Staphylococcus aureus (MRSA), three of which carried both MRSA and induced clindamycin resistance (ICR). GNB showed high resistance to ceftazidime, ceftriaxone and cefepime. Extended-spectrum beta-lactamases were presented by 69.4% of E.coli (n = 43/62) and 83.3% of K. pneumoniae (n = 25/30). Overall, twelve Gram-negative bacteria (5.24%) showed resistance to at least one carbapenem. No isolates showed a wild-type susceptible phenotype.ConclusionThis study shows the alarming prevalence of multidrug-resistant organisms from surgical site infections in Benin hospitals. To reduce the spread of such bacteria in Benin, periodic surveillance of surgical site infections and strict adherence to good hand-hygiene practice are essential.

Hematopoietic stem cell transplantation does not increase the risk of infection-related complications for pediatric patients with Hodgkin and non-Hodgkin lymphomas: A multicenter nationwide study.

Hodgkin (HL) and non-Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%-30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second-line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear. The aim of this population-based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL. We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second-line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally. Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P=.151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram-positives were predominant. The rate of multidrug-resistant bacteria was high, especially for Gram-negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection-related mortality was comparable for each group. The incidence of IC was comparable during first- and second-line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy.

Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections

The aim of this planned analysis of the prospective multinational TAVeM database was to determine the incidence, aetiology and impact on outcome of ventilator-associated lower respiratory tract infections (VA-LRTI) in immunocompromised patients.All patients receiving mechanical ventilation for >48 h were included. Immunocompromised patients (n=663) were compared with non-immunocompromised patients (n=2297).The incidence of VA-LRTI was significantly lower among immunocompromised than among non-immunocompromised patients (16.6% versus 24.2%; sub-hazard ratio 0.65, 95% CI 0.53-0.80; p<0.0001). Similar results were found regarding ventilator-associated tracheobronchitis (7.3% versus 11.6%; sub-hazard ratio 0.61, 95% CI 0.45-0.84; p=0.002) and ventilator-associated pneumonia (9.3% versus 12.7%; sub-hazard ratio 0.72, 95% CI 0.54-0.95; p=0.019). Among patients with VA-LRTI, the rates of multidrug-resistant bacteria (72% versus 59%; p=0.011) and intensive care unit mortality were significantly higher among immunocompromised than among non-immunocompromised patients (54% versus 30%; OR 2.68, 95% CI 1.78-4.02; p<0.0001). In patients with ventilator-associated pneumonia, mortality rates were higher among immunocompromised than among non-immunocompromised patients (64% versus 34%; p<0.001).Incidence of VA-LRTI was significantly lower among immunocompromised patients, but it was associated with a significantly higher mortality rate. Multidrug-resistant pathogens were more frequently found in immunocompromised patients with VA-LRTI.

Distribution of Multidrug-Resistant Bacteria and Antibiotic-Resistant Genes in Livestock Manures

In the present study, techniques for microbial culture enumeration, 16S rDNA gene sequencing for bacterial identification, high-throughput sequencing for the multidrug-resistant bacteria (MRB) communities, and high-throughput quantitative PCR detection for the prevalence and abundance of antibiotic resistance genes (ARGs) were conducted to investigate the distribution characteristics of MRB and ARGs in chicken and swine manures. The results showed that the rates of MRB that were resistant to tetracycline, ciprofloxacin, and gentamycin simultaneously were from 7.96% to 12.40% for the different manure samples. The dominant genera of cultivable MRB were Escherichia, Acinetobacter, and Proteus, both in the chicken and swine manures. High-throughput quantitative PCR results indicated that, compared to the antibiotic free swine manure, the total enrichment of ARGs increased by 1.96×104-1.54×105 times that in the swine manure samples, with different antibiotics following the sequence of tetracyclines > β-lactams > MLSB (macrolide, lincosamide, and streptogramin B) > aminoglycosides > FCA (fluoroquinolone, quinolone, florfenicol, chloramphenicol, and amphenicol) > sulfonamides > vancomycins.

A mathematical model for predicting the development of bacterial resistance based on the relationship between the level of antimicrobial resistance and the volume of antibiotic consumption.

Infections that are inadequately treated owing to acquired bacterial resistance are a leading cause of mortality. Rates of multidrug-resistant bacteria are rising, resulting in increased antibiotic failures and worsening patient outcomes. Mathematical modelling makes it possible to predict the future spread of bacterial antimicrobial resistance. The aim of this study was to construct a mathematical model that can describe the dependency between the level of antimicrobial resistance and the amount of antibiotic usage. After reviewing existing mathematical models, a cross-sectional, retrospective study was carried out to collect clinical and microbiological data across 3000 patients for the construction of the mathematical model. Based on these data, a model was developed and tested to determine the dependency between antibiotic usage and resistance. Consumption of inhibitor/cephalosporins and fluoroquinolones increases inhibitor/penicillin resistance. Consumption of inhibitor/penicillins increases cephalosporin resistance. Consumption of inhibitor/penicillins increases inhibitor/cephalosporin resistance. It was demonstrated that in some antibiotic-micro-organism pairs, the level of antibiotic usage significantly influences the level of resistance. The model makes it possible to predict the change in resistance and also shows the quantitative effect of antibiotic consumption on the level of bacterial resistance.

Nursing home-acquired pneumonia presenting at the emergency department.

Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5% of patients and median age was 84years old (IQR 77-90). Comorbidities were present in 69.8% of cases and 48.3% of patients had used healthcare services during the previous 90days. In-hospital mortality rate was 46.6% and median length-of-stay was 9days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n=0; one: n=7 (0%); two: n=18 (38.9%); three: n=26 (38.5%); four: n=30 (53.3%); and five; n=22 (68.2%); and sepsis n=50 (34.0%), severe sepsis n=43 (48.8%) and septic shock n=22 (72.7%). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p=0.001), age≥75years (p=0.02), and severe sepsis or shock (p=0.03) at the ED. Microbiological testing in 78.4% of cases was positive in 15.4% (n=15): methicillin-resistant Staphylococcus aureus (26.7%), Pseudomonas aeruginosa (20.0%), S. pneumoniae (13.3%), Escherichia coli (13.3%), others (26.7%); the rate of MDR bacteria was 53.3%. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

Pharmacotherapy of Complicated Urinary Tract and Intra-abdominal Infections with Doripenem

Due to the growing rate of multi-drug resistant bacteria in complicated infections, the need for new broad-spectrum antimicrobials is paramount. Doripenem, a new addition to the intravenous carbapenem class, has recently been approved for the treatment of complicated lower urinary tract infections and/or pyelonephritis (cUTI) and complicated intra-abdominal infections (cIAI) in adult patients. Doripenem exhibits potent in vitro and in vivo bactericidal activity against an assortment of Gram-positive and Gram-negative aerobic and anaerobic organisms, including Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae that produce extended spectrum beta-lactamases (ESBL). Relative to other available carbapenems, doripenem typically displays MICs that are 1-2 dilutions lower than meropenem and 2-4 dilutions lower than imipenem against P. aeruginosa. Since the kidneys primarily excrete doripenem as whole drug, dose adjustments are needed in patients with renal impairment. Doripenem 500 mg q8 h demonstrated non-inferiority to levofloxacin 250 mg q24 h in clinical trials of patients with cUTI; it was non-inferior to meropenem 1000 mg q8 h in patients with cIAI. Doripenem's broad spectrum of activity, in vitro potency against particularly difficult to treat organisms, and desirable safety profile make it an attractive option in the treatment of cUTI and cIAI.

La lutte contre la résistance aux antibiotiques passe aussi par l'information aux parents

Antibiotic resistance is becoming worldwide a major challenge. Increasing rate of multidrug resistant bacteria is directly linked with the consumption of antibiotic. Children are the greatest consumers of antibiotics, but this large pediatric prescription is not justified, and responds, at least in part, to a "parental pressure". Therefore information to the parents about antibiotic is recommended. In order to promote this information the American Academy of Pediatrics recently wrote a booklet entitled "Your child and antibiotics" which is presented.