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.
Amoxicillin
/ pharmacology
Anti-Bacterial Agents
/ pharmacology
Cephalosporins
/ pharmacology
Child
Child, Preschool
Chromatography, High Pressure Liquid
Drug Prescriptions
/ statistics & numerical data
Drug Resistance, Bacterial
Enterobacteriaceae
/ drug effects
Female
Follow-Up Studies
Gastrointestinal Microbiome
/ drug effects
Humans
Infant
Male
Outpatients
Prospective Studies
Respiratory Tract Infections
/ diagnosis
Severity of Illness Index
Vietnam
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
10
10
2019
accepted:
20
10
2020
entrez:
4
11
2020
pubmed:
5
11
2020
medline:
29
12
2020
Statut:
epublish
Résumé
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. 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. 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. 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. This study was registered at the International Standard Randomised Controlled Trials Number registry under number ISRCTN32862422: http://www.isrctn.com/ISRCTN32862422.
Sections du résumé
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.
Identifiants
pubmed: 33147269
doi: 10.1371/journal.pone.0241760
pii: PONE-D-19-28321
pmc: PMC7641406
doi:
Substances chimiques
Anti-Bacterial Agents
0
Cephalosporins
0
Amoxicillin
804826J2HU
Banques de données
ISRCTN
['ISRCTN32862422']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0241760Subventions
Organisme : Wellcome Trust
ID : 077078/Z/05/Z
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 089276/Z/09/Z
Pays : United Kingdom
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Virol Methods. 2007 May;141(2):205-11
pubmed: 17218020
Cochrane Database Syst Rev. 2011 Jun 15;(6):CD005189
pubmed: 21678346
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD004874
pubmed: 20238334
Biomed Chromatogr. 2020 Jan;34(1):e4699
pubmed: 31524294
Clin Microbiol Infect. 2006 Jun;12(6):571-5
pubmed: 16700707
Trop Med Int Health. 2000 Oct;5(10):711-21
pubmed: 11044266
J Clin Microbiol. 2001 Apr;39(4):1553-8
pubmed: 11283086
Br J Gen Pract. 2006 Mar;56(524):164-6
pubmed: 16536953
Lancet Glob Health. 2016 Sep;4(9):e633-41
pubmed: 27495137
Scand J Prim Health Care. 2008;26(4):211-5
pubmed: 18615361
Cochrane Database Syst Rev. 2014 Mar 01;(3):CD000245
pubmed: 24585130
Elife. 2016 Sep 06;5:
pubmed: 27599374
Nat Rev Microbiol. 2010 Apr;8(4):260-71
pubmed: 20208551
Infect Immun. 2000 Mar;68(3):1374-82
pubmed: 10678950
J Clin Microbiol. 2003 Feb;41(2):576-80
pubmed: 12574249
Clin Infect Dis. 2012 Nov 15;55(10):1279-82
pubmed: 23091044
Arch Dis Child. 2017 Jul;102(7):660-666
pubmed: 28119402
J Microbiol Methods. 2003 Oct;55(1):149-53
pubmed: 14500006
Glob Health Action. 2017;10(1):1327638
pubmed: 28590792
PLoS One. 2012;7(5):e38271
pubmed: 22693610
JAMA Intern Med. 2014 Dec;174(12):1914-20
pubmed: 25285394
Br J Gen Pract. 2005 Aug;55(517):603-8
pubmed: 16105368
JAMA. 2004 Apr 7;291(13):1587-95
pubmed: 15069046
Science. 2000 Feb 25;287(5457):1479-82
pubmed: 10688795
J Clin Microbiol. 2001 May;39(5):1963-6
pubmed: 11326023
Br J Gen Pract. 2004 Sep;54(506):653-8
pubmed: 15353049
J Clin Microbiol. 2004 Sep;42(9):4355-7
pubmed: 15365043
Int J Infect Dis. 2019 Sep;86:73-81
pubmed: 31247341
J Clin Microbiol. 2002 May;40(5):1719-22
pubmed: 11980949
PLoS Pathog. 2009 Aug;5(8):e1000541
pubmed: 19662169
Proc Natl Acad Sci U S A. 2006 May 2;103(18):6976-81
pubmed: 16636273
BMC Pharmacol Toxicol. 2014 Feb 20;15:6
pubmed: 24555709
Proc Natl Acad Sci U S A. 1998 Mar 31;95(7):3949-53
pubmed: 9520473
Cochrane Database Syst Rev. 2013 Nov 05;(11):CD000023
pubmed: 24190439
J Clin Virol. 2005 Aug;33(4):306-11
pubmed: 15994117
Proc Biol Sci. 1997 Sep 22;264(1386):1287-91
pubmed: 9332013
J Clin Virol. 2011 Jul;51(3):179-85
pubmed: 21571585
PLoS One. 2011 Mar 24;6(3):e18176
pubmed: 21455313
PLoS One. 2017 Jul 14;12(7):e0180630
pubmed: 28708872
Antimicrob Agents Chemother. 2012 Mar;56(3):1418-26
pubmed: 22232285
Trop Med Int Health. 2011 Jun;16(6):737-43
pubmed: 21410602
Br J Gen Pract. 2009 Oct;59(567):e321-8
pubmed: 19843412