1. Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study
- Author
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Constance Schultsz, Le thi Ngoc Kim, Thai Dang Khoa, Pham Quynh Vi, H. Rogier van Doorn, Juliet E. Bryant, James Campbell, Pham Nguyen Phuong, Vu Thi Ty Hang, Nguyen Thi Ngoc, Thomas Pouplin, Christopher M. Parry, Nguyen Thi Thuy Chinh B’Krong, Nguyen Thi Hong Tham, Huynh Duy Khuong, Nguyen Ngoc Hong Phuc, Phung Khanh Lam, Menno D. de Jong, Doan Van Khanh, Nguyen Hanh Uyen, Le Binh Bao Tinh, Nguyen Thanh Hung, Stephen Baker, Pham Van Toi, Heiman F. L. Wertheim, Ngo Ngoc Quang Minh, Le Minh Qui, Le Thi Minh Vien, Global Health, AII - Infectious diseases, APH - Global Health, Khanh, Doan Van [0000-0002-7251-3599], van Doorn, H Rogier [0000-0002-9807-1821], and Apollo - University of Cambridge Repository
- Subjects
0301 basic medicine ,Male ,Pulmonology ,Physiology ,Tonsillitis ,Antibiotics ,Cephalosporin ,Urine ,Pathology and Laboratory Medicine ,Severity of Illness Index ,0302 clinical medicine ,Medical Conditions ,Outpatients ,Medicine and Health Sciences ,wc_505 ,030212 general & internal medicine ,Prospective Studies ,Child ,Respiratory Tract Infections ,Chromatography, High Pressure Liquid ,Multidisciplinary ,Antimicrobials ,Drugs ,Pharyngitis ,3. Good health ,Bacterial Pathogens ,Body Fluids ,Anti-Bacterial Agents ,Infectious Diseases ,Vietnam ,Medical Microbiology ,Viral Pathogens ,Child, Preschool ,Viruses ,Medicine ,Female ,medicine.symptom ,Pathogens ,Anatomy ,medicine.drug ,Research Article ,medicine.medical_specialty ,Patients ,medicine.drug_class ,Science ,030106 microbiology ,wa_395 ,Microbiology ,Drug Prescriptions ,ws_310 ,03 medical and health sciences ,Respiratory Disorders ,Antibiotic resistance ,All institutes and research themes of the Radboud University Medical Center ,Enterobacteriaceae ,Internal medicine ,Clavulanic acid ,Microbial Control ,Drug Resistance, Bacterial ,medicine ,Humans ,Microbial Pathogens ,Pharmacology ,Bacteria ,business.industry ,qw_138 ,Organisms ,Biology and Life Sciences ,Amoxicillin ,Infant ,qv_350 ,medicine.disease ,Cephalosporins ,Gastrointestinal Microbiome ,Health Care ,ws_200 ,Pneumonia ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Antibiotic Resistance ,Respiratory Infections ,Antimicrobial Resistance ,business ,Follow-Up Studies - Abstract
Background and objectives Treatment guidelines do not recommend antibiotic use for acute respiratory infections (ARI), except for streptococcal pharyngitis/tonsillitis and pneumonia. However, antibiotics are prescribed frequently for children with ARI, often in absence of evidence for bacterial infection. The objectives of this study were 1) to assess the appropriateness of antibiotic prescriptions for mild ARI in paediatric outpatients in relation to available guidelines and detected pathogens, 2) to assess antibiotic use on presentation using questionnaires and detection in urine 3) to assess the carriage rates and proportions of resistant intestinal Enterobacteriaceae before, during and after consultation. Materials and methods Patients were prospectively enrolled in Children’s Hospital 1, Ho Chi Minh City, Vietnam and diagnoses, prescribed therapy and outcome were recorded on first visit and on follow-up after 7 days. Respiratory bacterial and viral pathogens were detected using molecular assays. Antibiotic use before presentation was assessed using questionnaires and urine HPLC. The impact of antibiotic usage on intestinal Enterobacteriaceae was assessed with semi-quantitative culture on agar with and without antibiotics on presentation and after 7 and 28 days. Results A total of 563 patients were enrolled between February 2009 and February 2010. Antibiotics were prescribed for all except 2 of 563 patients. The majority were 2nd and 3rd generation oral cephalosporins and amoxicillin with or without clavulanic acid. Respiratory viruses were detected in respiratory specimens of 72.5% of patients. Antibiotic use was considered inappropriate in 90.1% and 67.5%, based on guidelines and detected pathogens, respectively. On presentation parents reported antibiotic use for 22% of patients, 41% of parents did not know and 37% denied antibiotic use. Among these three groups, six commonly used antibiotics were detected with HPLC in patients’ urine in 49%, 40% and 14%, respectively. Temporary selection of 3rd generation cephalosporin resistant intestinal Enterobacteriaceae during antibiotic use was observed, with co-selection of resistance to aminoglycosides and fluoroquinolones. Conclusions We report overuse and overprescription of antibiotics for uncomplicated ARI with selection of resistant intestinal Enterobacteriaceae, posing a risk for community transmission and persistence in a setting of a highly granular healthcare system and unrestricted access to antibiotics through private pharmacies. Registration This study was registered at the International Standard Randomised Controlled Trials Number registry under number ISRCTN32862422: http://www.isrctn.com/ISRCTN32862422
- Published
- 2020