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Acute Tonsillitis and Bronchitis in Russian Primary Pediatric Care: Prevailing Antibacterial Treatment Tactics and Their Optimization
Vladimir Tatochenko,
Eugenia Cherkasova,
Tatjana Kuznetsova,
Diana Sukhorukova,
Maya Bakradze
Issue:
Volume 4, Issue 3, September 2018
Pages:
46-51
Received:
25 May 2018
Accepted:
27 June 2018
Published:
26 July 2018
Abstract: Inappropriate use of antibiotics in children with acute tonsillitis (AT) and bronchitis is an important cause of the microbial resistance. The aim of the study was to find out pediatricians’ motives in prescribing antibiotics and the extent of their inappropriate use in these cases, as well as maternal attitudes to the use of antibiotics in acute viral respiratory infections (ARI). We also studied in the context of regular primary pediatric care the acceptability to parents of a judicious use of antibiotics. Pediatricians (n=97) attitudes to antibiotics and their practices were studied by a questionnaire in 4 cities of Russia, mothers’ attitudes to antibiotics (n=107) and antibiotic use frequencies were studied in an Oryol polyclinic. Optimization of treatment studies (acute tonsillitis 1577 child-years, acute bronchitis 3303 child-years of observations) were conducted by two co-authors in their capacity of primary pediatric providers (for about a 1000 children each) in a polyclinics of Oryol. Antibiotics were given only to AT cases found positive for hemolytic streptococcus (GABHS) by an express-test. Patients with acute bronchitis and bronchiolitis were treated by inhalation of 0.9% or 3% saline solutions. Most (95-100%) pediatricians consider tonsillitis (without bacteriological evidence obtained at the point of care) to be of bacterial origin and treat it with antibiotics - for the fear of GABHS complications, self-protection or as a traditions. About a half of mothers would add antibiotics to whatever else pediatrician prescribes for ARI, 1/3 mothers prefer self-treatment with antibiotics if body temperature is over 38°C. Of tonsillitis patients 80.5% and of bronchitis over 70% - are treated in the outpatient setting with antibiotics. The incidence of tonsillitis was 80 per 1000 children of all ages, the proportion of GABHS-tonsillitis - 27% - only in children above 4 years of age (population incidence 7.5 per 1000). 87% of mothers of GABHS negative children accepted treatment without antibiotics. Similarly, 88.5% of parents of children with bronchiolitis (incidence 113 per 1000 0-2 years old) and acute bronchitis (61 per 1000 0-18 years old) agreed to use only saline inhalations. We conclude that additional attention to mothers (explaining results of the express-test, or teaching how to do inhalation) overcome their fears of withholding antibiotics.
Abstract: Inappropriate use of antibiotics in children with acute tonsillitis (AT) and bronchitis is an important cause of the microbial resistance. The aim of the study was to find out pediatricians’ motives in prescribing antibiotics and the extent of their inappropriate use in these cases, as well as maternal attitudes to the use of antibiotics in acute v...
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Pasteurella multocida Peritonitis in a 3-Year-Old Patient Undergoing Peritoneal Dialysis: Case Report and Review of the Literature
Hiroshi Tamura,
Shohei Kuraoka,
Tomomi Nishi,
Yuko Hidaka,
Hiroko Nagata,
Hiroko Nagata,
Hitoshi Nakazato
Issue:
Volume 4, Issue 3, September 2018
Pages:
52-55
Received:
1 June 2018
Accepted:
26 June 2018
Published:
26 July 2018
Abstract: Pasteurella multocida has been rarely reported to cause peritonitis in children. Peritoneal dialysis (PD) peritonitis is associated with high mortality despite appropriate treatment; therefore, its early detection is essential. Here, we report the case of a 3-year-old girl, undergoing treatment with PD, who developed peritonitis caused by P. multocida after a domestic cat scratched a dialysate bag used for PD. The patient was treated with antibiotics and her condition was soon in remission. PD peritonitis can occur despite the isolation of equipment, as in this case, it is preferable to completely avoid having pets if possible. But, there is the benefit of pets which heal the minds of humans with a chronic illness. We propose that it is preferable for PD patients to keep pets away from rooms where they store PD equipment and perform PD.
Abstract: Pasteurella multocida has been rarely reported to cause peritonitis in children. Peritoneal dialysis (PD) peritonitis is associated with high mortality despite appropriate treatment; therefore, its early detection is essential. Here, we report the case of a 3-year-old girl, undergoing treatment with PD, who developed peritonitis caused by P. multoc...
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Epidemiology and Outcome of Acute Bacterial Meningitis Among Children in Saudi Haospital Hajjah, Northwest Territories of Yemen
Ahmed Hamood Alshehari,
Abdulhakim Ali Mohammed Al-Selwi,
Mohamed Abdulhadi Albahloly
Issue:
Volume 4, Issue 3, September 2018
Pages:
56-60
Received:
16 May 2018
Accepted:
3 July 2018
Published:
30 July 2018
Abstract: This is a retrospective descriptive study carried out in Saudi Hospital Hajjah between July 2016 and December 2017: The aim of this study is to assess the etiology and outcome of acute bacterial meningitis among children in Saudi Hospital Hajjah. We included in this study all children aged one month or more to 12 years who had symptoms and signs suggested acute bacterial meningitis confirmed by lumber puncture of cerebrospinal fluid for cells, biochemistry and culture. The data of all patients were retrieved from the hospital records and patient`s charts. These data included age, clinical presentation, etiologic microorganism and outcome. A total of 196 patients who had confirmed bacterial meningitis was recorded. Of these, 71 patients (36.2%) were aged under 12 months, 25% aged between 1-2 years old, 17.9% between 3-5 years and 20.9% > 5 years. Cerebrospinal fluid culture was positive among 94.9% of patients. Among the positive isolates, 43.5% were having Nesseria meningitidis, 34.9% Streptococcus pneumonia, 18.2% Hemophillus influenza type b, 2.7% group B Streptococci and 0.5% E.coli. There were 19 patients died giving the case fatality rate as 9.7%. Of those, 47.3% had aged less than 12 months, 31.5% aged 1-2 years, one child (5.2%) aged 4 years and 3 cases (15.8%) were > 5 years. Eleven cases of deaths (57.9%) had s. pneumonia infections. There were 24 patients (12.2%) of survivors developed neurological complications. This study demonstrates that there is no change in the epidemiology of the main causes of acute bacterial meningitis among children compared to that reported prior to introduction Hib and pneumococcal vaccines indicating a limited coverage of vaccination in the Northwest Territories of Yemen. The case fatality rate noted in this study is relatively low, but aggressive efforts by the health care system both to vaccinate and to early treat infected children, meningitis incidence and mortality will decline.
Abstract: This is a retrospective descriptive study carried out in Saudi Hospital Hajjah between July 2016 and December 2017: The aim of this study is to assess the etiology and outcome of acute bacterial meningitis among children in Saudi Hospital Hajjah. We included in this study all children aged one month or more to 12 years who had symptoms and signs su...
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Acute and Chronic Renal Diseases Associated with Different Drugs in Children
Sergey Postnikov,
Anna Gratzhianskaya,
Marya Kostyleva,
Aleksey Ermilin
Issue:
Volume 4, Issue 3, September 2018
Pages:
61-68
Received:
28 June 2018
Accepted:
19 August 2018
Published:
19 September 2018
Abstract: Drugs are common cause of renal damage - approximately 20% of out-patient and in-patient cases of acute renal failure are caused by drugs. The main reasons for this situation are the following: rapid growth of pharmaceutical market and therefore increased amount of drugs with known nephrotoxicity, aging of the population that is accompanied by the accumulation of such diseases like diabetes mellitus (DM), heart failure (HF), arterial hypertension (AH) following by the obligatory polypharmacy. On the other hand the achievements of contemporary medical science contribute to survivals of significant quantity of premature neonates with low and extremely low body weight. Thus the different types of pathological conditions like bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), sepsis, pneumonia, necrotic enterocolitis corresponding to such category of patients require aggressive treatment with off-label use. All factors listed above contribute to drug overload in the mentioned age-groups including drugs excreted by kidneys with possible damage of different renal structures and functions. The primary preventive measures could be the following: avoidance of the combination of drugs with known nephrotoxic effect, sufficient hydration and assessment of renal functioning using current biomarkers measuring before and in the progress of the treatment with potential nephrotoxic effect. It could be recommended the decreasing dose or interruption of the suspected drug in accordance with the deviation of parameters comparing to the baseline.
Abstract: Drugs are common cause of renal damage - approximately 20% of out-patient and in-patient cases of acute renal failure are caused by drugs. The main reasons for this situation are the following: rapid growth of pharmaceutical market and therefore increased amount of drugs with known nephrotoxicity, aging of the population that is accompanied by the ...
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Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya
Elizabeth Wanjiku Ndungu,
Florence Nafula Okwara,
John Paul Oyore
Issue:
Volume 4, Issue 3, September 2018
Pages:
69-79
Received:
6 September 2018
Accepted:
19 September 2018
Published:
12 October 2018
Abstract: Acute respiratory infection (ARI) is a leading cause of childhood morbidity and mortality in developing countries. In Kenya, diagnosis and treatment of ARI remains predominantly health facility based. This presumes that caretakers can recognize ARI symptoms promptly and make a decision to take the child to an appropriate health facility for treatment. Unfortunately, these presumptions have not been assessed. This study sought to establish determinants of health care seeking among caretakers of children under five years (CU5) of age with ARI. An analytic cross sectional survey was carried out in Githunguri Sub - County of Kiambu County. Households with CU5 who had recently suffered an episode of ARI were enrolled. Structured questionnaires, focused group discussions and key informant guides were used to gather information. Structured questionnaires were administered to caretakers to obtain information on socio-demographics, knowledge and health seeking practices. Bivariate and multivariate analysis was carried out with a p value of < 0.05. From 438 households sampled, 323 (73.7%) had CU5 in their households. Out of these, 240 (74.3%) of the children had an episode of ARI in the preceding 2 weeks. The mean age of the children was 29.2 months, with male to female ratio of 1:1. The mean mothers’ age was 29.4 years, 71.2% were married, 54.8% had secondary education and 66.6% were of Christian-protestants faith and (90.0%) were in informal employment. Poor knowledge of pneumonia was documented in 92.5% of caretakers. One hundred and forty nine (62.1%) caretakers had delayed health facility consultation for ARI. The main factors associated with delayed facility consultation were poor knowledge of symptoms (p = 0.007) long distance to the nearest health facility (p = 0.002), means of transport used to access the nearest health facility (p = 0.001) and previous high expenditure at health facility (p = 0.011). On logistic regression, the main factors that independently determined delayed facility consultation were long waiting time (>1hour) before service provision (p = 0.001), use of a motorbike to access the nearest health facility (p = 0.001) and traveling for 4 - 4.9 kilo meters to the nearest health facility (p = 0.002). Travelling for long distance and long waiting time before service provision during the previous facility visit were the main determinants of delayed facility consultations. The study recommends increased sensitization on symptom recognition among caretakers, and intensified efforts to reduce turn-around time during health facility consultations in order to minimize delays in health facility consultation.
Abstract: Acute respiratory infection (ARI) is a leading cause of childhood morbidity and mortality in developing countries. In Kenya, diagnosis and treatment of ARI remains predominantly health facility based. This presumes that caretakers can recognize ARI symptoms promptly and make a decision to take the child to an appropriate health facility for treatme...
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