Showing posts with label antibiotics. Show all posts
Showing posts with label antibiotics. Show all posts

Friday, July 24, 2015

Antibiotic Usage and Juvenile Idiopathic Arthritis—an Interesting Association

By: Lewis First, MD, MS; Editor-in-Chief   

          We all know that drugs can have unexpected side effects.  This week, Horten et al. (doi: 10.1542/peds.2015-0036) share a possible association between antibiotic exposure and juvenile idiopathic arthritis (JIA).   In a case-control study looking at children with newly diagnosed JIA and a matched set of controls, the authors kept track of the number and timing of antibiotic courses prior to diagnosis adjusting for key confounders.  
     The results are a significant association as you might expect by the fact that we are highlighting this study—but what does it mean and why would taking antibiotics lead to an autoimmune disease like JIA?  The authors offer their take in the Discussion section of the study and so do infectious disease experts Drs. Jennifer Goldman and Mary Anne Jackson in an accompanying commentary (doi: 10.1542/peds.2015-1296).   
     There is a lot to be learned and thought about in this study and commentary.  In turn, be aware of this association and perhaps families who ask for antibiotics for what is likely something viral might be less apt to request them as a result of sharing what you learn with them from this article.

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Monday, July 20, 2015

Are Parental Requests for Antibiotics for Their Children Decreasing Over Time? New Survey Doses Out Some Interesting Findings

By: Lewis First, MD, MS; Editor-in-Chief  

          With the rise in antibiotic resistance over the past few decades, there has been an increased effort by all of us to become stricter in our use of these antimicrobials—but have those efforts paid off?  Vaz et al. (doi:10.1542/peds.2015-0883) opted to study this question by surveying 1500 parents of children less than 6 years of age to determine their knowledge and attitudes toward use of antibiotics.  The authors divided respondents in terms of their insurance status as being in Medicaid managed care or a commercial health plan. The results are worth reading and thinking about.  For example, while we’ve made some headway in more parents recognizing that green nasal discharge does not require a prescription for an antibiotic, the improvement is less visible amongst Medicaid-enrolled families who continue to request that unnecessary antibiotics be prescribed.  There are many other variables identified that may be causing parents to request unneeded antibacterial medication, and the authors do a nice job of identifying them in their study.
          So what does this study mean for your practice?  Do you agree that your patient education efforts have been in vain when it comes to reducing their requests for antibiotics in likely viral scenarios, or have you succeeded where this study has not?  Doctor Sharon Meropol and Doctor Mark Votruba (doi: 10.1542/peds.2015-1780) add their opinion in an accompanying commentary to this study that you should turn to after reviewing the published data, but just as importantly, we would love to hear your thoughts and ideas on what works when it comes to educating families and changing their antibiotic-seeking behavior by responding to this blog, sending us an e-letter or posting your thoughts on our Facebook or Twitter websites.  

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Wednesday, April 1, 2015

Antibiotic Usage in Infancy and Being Overweight: Weighing in on an Unexpected Association

By: Lewis First, MD, MS; Editor-in-Chief  
     How often have you considered that antibiotics given in infancy might predispose your patient to being overweight by age 2 years?  We certainly did not until we read the study by Saari et al. (doi: 10.1542/peds.2014-3407) and realized that the intestinal microbiome might be the culprit responsible for such an association. 
     The authors studied a population-based cohort of approximately 6 thousand boys and a similar number of girls in the first 24 months of life and looked at antibiotic purchase data as well as body mass index and height at 2 years of age. Since antibiotics can change the human microbiome, especially in infancy, doing so may trigger additional weight gain. 
      Why this happens is the subject of a provocative discussion section of this study, making this article well worth your attention. 

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Friday, March 13, 2015

Building a Better Mousetrap: Ever Evolving Bacteremia Vs Ever Changing Physicians

Editorial Board Member Joann Schulte, DO, MPH  

       Charles Darwin took a voyage around the world on the Beagle to come up with his theory of evolution and he needed years to develop it. Evolution among the bacteria has been proceeding at a faster pace according to new research from Irwin et al. (doi: 10.1542/peds.2014-2061) in this month’s Pediatrics.
      Researchers at Alder Hey Children’s emergency department, which is the United Kingdom’s busiest such unit for children, chronicled changes among patients with bacteremia between 2001 and 2011. The hospital ER has 60,000 visits in a year, and the authors examined all positive blood cultures isolated during the study period. They also extracted clinical data on demographics, co-morbidities, and other laboratory results.
      Their researchers showed that among the 575 infections recorded, those preventable by vaccines  have been reduced and gram-negative infections have increased during the time period studied.  Health care-associated bacteremia (as a result of an underlying chronic disease like leukemia or secondary to having an indwelling central venous line) increased from 0.17 to 0.43 per 1000 children seen in the ER, and such admissions required longer hospital stays. 
      The authors’ decade-long look is a worthwhile reminder that the demographics of children with bacteremia have changed as have the organisms with which they’re infected.  The job of pediatricians has gotten tougher in the UK, and the same is true here in the US. In fact, a great idea is to review the reports of antimicrobial resistance patterns reported at your local hospital’s  microbiology laboratory and ask the infectious disease specialist(s) there if they are seeing similar trend changes as seen in this interesting article. 
      The bugs that are seriously infecting our patients are evolving and your practice must do so too to manage these children optimally.  Physicians practicing today have to evolve at a much faster and accurate pace than Darwin’s ideas and theories did.  None of that is really headline news if you read medical journals, but the UK article is a good summary of the overall trends of bacteremia among children.

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Friday, December 19, 2014

Preventing Hazardous Drug-Drug Interactions in Children

Photo Courtesy of Kathea Pinto
Editorial Board Member Joann Schulte, DO, MPH

Drug-Drug interactions remind me of Haiti.  Specifically I think of the bokor (folk medicine healer vs. witch doctor) who used to sit under the flambeau trees at an outdoor market at Deschappelles, near the compound of Albert Schweitzer Hospital. He would set out a lazy susan swirl tray of capsules and tablets arranged by color. Patients would spin it like like a Vegas roulette wheel, picking a pink one and a turquoise one or some other mixture for malaria or hypertension. The hospital staff was persistent in telling patients that you couldn't take medicine that way. But the bokor always had supplies and customers, some of whom ended up admitted to the hospital.

I think about that roulette twirl these days as I’m learning more about Drug-Drug interactions in the US in a medical toxicology fellowship at the North Texas Poison Control Center in Dallas Parkland Hospital. Bad pharmaceutical consumption out of home medicine cabinets is a common history I hear. Every week or so I see patients who jiggered up their personal suicide attempts with a combination of benzodiazepines, street drugs, opioids and alcohol. Other patients are toddlers who went candy hunting in grandmother’s purse. 

Another category of drug interactions –unintended and often undetected– occurs in US hospitals. Those Drug-Drug interactions are the focus of a study published in Pediatrics this month.

Dr. Feinstein et al. (doi: 10.1542/peds.20142015) investigated potential Drug-Drug interactions (PDDI) among almost half a million hospitalizations in 2011 in forty-three pediatric hospitals.   They classified PDDI as contraindicated (shouldn’t be used together), major (life-threatening or medical intervention needed), moderate (may change the patient’s condition or require medical intervention) and minor (limited clinical effect).  They used an administrative database to calculate the potential interactions in a retrospective cohort study.

The researchers from Colorado and Philadelphia founded that 49% of the admitted children (approximately 245,000) had one or more PDDI. A contradicted PDDI occurred in 1% of admissions.  Opioids were were involved in 25% of of all PDDI, followed by anti-infective agents (17%), neurologic agents (15%), neurological agents (15%), gastrointestinal agents (13%) and cardiovascular agents (13%).

The likelihood of PDDI exposures increased with length of hospital stay. Among infants, 21.8% were exposed to a PDDI on the first day.

The authors have done a study showing potential PDDI, not actual data and have done it using an administrative database. But their work is important because it suggests how frequent Drug-Drug interactions might be. The numbers of reported adverse drug events are much lower. In 2003, 10% of pediatric hospitalizations were reported to have included an adverse drug effect.  

In short, the work done by the Colorado and Philadelphia researchers suggests that actual prevalence of Drug-Drug interactions might be under reported. More work is needed to verify how often such Drug-Drug interactions happen. There’s a big gap between the potential 49% reported here and the actual reported 10%.

Monday, December 8, 2014

Antimicrobial Stewardship Programs: Are They Making a Difference?

We certainly know the dangers of antibiotic overuse and want to be good stewards of our antibacterial medications—especially if the odds point in the direction of a viral etiology for a child’s symptoms. Yet despite our ability to talk the talk, do we walk the walk when it comes to being good stewards of antimicrobial agents?

Some hospitals, to further enhance the prudent usage of antimicrobials, have instituted stewardship programs to reduce and improve antibiotic prescribing. Do these programs work?

Hersh et al. (doi:10.1542/peds.2014-2579) looked at a group of children’s hospitals with formalized antibiotic stewardship programs (ASPs) compared to hospitals without such programs and looked at antibiotic prescribing over time in those hospitals. The results are not a bitter pill to swallow but are, instead, quite promising. This is especially true for those hospitals administering certain subsets of antibiotics, including vancomycin, carbapenems, and linezolid, that both did and did not follow stewardship guidelines.

So are these stewardship programs worth the investment? Infectious disease specialist Dr. Will Mason and colleagues dose out their thoughts on this issue in an accompanying commentary also being released this week.

Does your hospital offer a stewardship program? If so, do you think it has helped reduce the frequency of usage of antibiotics? If not, why? Feel free to share your thoughts on antibiotic stewardship by posting a response to this blog, sending us an e-letter or over on Facebook or Twitter.

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