JOURNAL CLUB: Systemic fluoroquinolone prescriptions for hos | Figure 1

I

InfectiousDiseaseJC

•Follow

Some actions are only available when you log in.

Report case

Report this to our moderators

JOURNAL CLUB: Systemic fluoroquinolone prescriptions for hospitalized children in Belgium

You can view up to 4 cases without signing up Sign up for unlimited access

Objective: To analyze indications for systemic FQ prescriptions in hospitalized children and the appropriateness of the prescribed dose.

Methods: Using data obtained from electronic medical files in two Belgian university children’s hospitals between 2010 and 2013. Logistic regression models were used to analyze risk factors for inadequately dosing.

Key findings: Infants and preschool children were at particular risk for inadequate dose, with associated adjusted OR of 0.263 (0.097–0.701) and 0.254 (0.106–0.588) respectively.

Questions:

  1. In table 3, the percentage of dose adequate were reported over 100%, why?
  2. How do you interpret adjusted OR as showed in key findings?
  3. Mycoplasma pneumonia is found to be the treatment challenge, why?
  4. Should if suspected mycoplasma pneumonia infection, what is the antibiotic of choice, why?

Full text here

Comment

Sign up to add a comment

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ What was the aim of this review?\ The aim of this Cochrane Review was to find out whether racecadotril works for children under five years of age with diarrhoea. Cochrane Review authors collected and analysed all relevant trials to answer this question and included seven trials in this review.\ Key messages\ Racecadotril may reduce the risk of rehydration failure. We are uncertain whether or not it influences number of bowel movements or duration of diarrhoea.\ What was studied in the review?\ Diarrhoea is a leading cause of death in children under five years old, especially in low‐income countries. Children who have diarrhoea often suffer from frequent and watery bowel movements, which might cause excessive loss of fluid and electrolytes (dehydration). Fluid replacement is recommended to prevent and treat dehydration caused by diarrhoea. Racecadotril has been used in addition to fluid replacement for treating diarrhoea in children, as it reduces release of water and electrolytes into the digestive tract. The drug is supposed to improve the symptoms of diarrhoea (shorten duration of diarrhoea or reduce the stool frequency) as well as reduce the risk of rehydration failure. However, it is not clear if racecadotril really works for children with diarrhoea.\ What are the main results?\ The review authors searched for available trials and included seven trials. The trials were conducted in a total of 1140 children aged from 3 months to 5 years. Children who were given racecadotril were compared to a control group (children who, instead of racecadotril, received a placebo (a dummy drug that contains no racecadotril) or no drug). The review shows that when children with diarrhoea were given racecadotril, compared to placebo or no drug:\ • racecadotril may reduce the risk of rehydration failure (low‐certainty evidence);\ • we are uncertain whether or not racecadotril shortens duration of diarrhoea (very low‐certainty evidence);\ • we are uncertain whether racecadotril influences the number of stools (very low‐certainty evidence);\ • racecadotril may reduce weight of stool output (low‐certainty evidence);\ • racecadotril may make little or no difference to length of hospital stay for inpatients (low‐certainty evidence);\ • racecadotril may make little or no difference to rates of side‐effect events (low‐certainty evidence)\ How up to date is this review?\ The review authors searched for trials published up to 4 March 2019.](https://app.figure1.com/case-detail/169a51dd-b895-4282-8f8f-085337ce4e3a)

\ \ Cochrane Review; 13 studies (2900 children)\ Key findings\ Results were available for three tools: Autism Diagnostic Observation Schedule (ADOS; Modules 1 and 2), (Childhood Autism Rating Scale (CARS); Autism Diagnostic Interview-Revised (ADI-R).\ If instruments were applied to 1000 children, 740 of whom had ASD, then 696, 592, and 385 children would be correctly identified by ADOS, CARS, and ADI-R, respectively, whereas 52, 31, and 42 children without ASD would be incorrectly classified as having ASD.\ Of 260 children without ASD, 208, 229, and 218 would be correctly classified by ADOS, CARS, and ADI-R, respectively, whereas 44, 148, and 355 children with ASD would be incorrectly classified as not having ASD.\ One publication looked at using ADI-R together with ADOS. Using both tools together was no more accurate than use of ADOS alone.\ Conclusions:\ Problems with how some studies were conducted and conflicts of interest may result in ADOS, CARS, and ADI-R appearing more accurate than they really are.\ Findings suggest that ADOS is best for not missing children who have ASD and is similar to CARS and ADI-R in not falsely diagnosing ASD in a child who does not have ASD.\ ADOS has acceptable accuracy in populations with a high prevalence of ASD. However, overdiagnosis is likely if the tool is used in populations with a lower prevalence of ASD.](https://app.figure1.com/case-detail/6259e27e-80ff-4c27-accd-b935a40cfdc9)

\ \ Which antibiotic regimen is safer and more effective in treating neonates (newborns) and children with hospital‐acquired pneumonia?\ Background\ Hospital‐acquired pneumonia is one of the most common hospital‐acquired infections in children worldwide, and is associated with a high death rate. Most of our understanding of hospital‐acquired pneumonia in children is drawn from adult studies. To our knowledge this is the first review with meta‐analysis that assesses the benefits and harms of different antibiotic regimens in newborns and children with hospital‐acquired pneumonia.\ We included four trials randomising 84 children with hospital‐acquired pneumonia to different antibiotic regimens.\ Each of the four included trials compared different antibiotic regimens, as follows: cefepime versus ceftazidime; linezolid versus vancomycin; meropenem versus cefotaxime; and ceftobiprole versus cephalosporin.\ Study funding sources\ Three trials were funded by pharmaceutical companies (Zeneca Pharmaceuticals, Pharmacia Corp, and Basilea Pharmaceutica International Ltd.), indicating a possible risk of bias related to a vested interest risk.\ Key results\ Each of the four included trials compared different antibiotic regimens, as follows: cefepime versus ceftazidime; linezolid versus vancomycin; meropenem versus cefotaxime; and ceftobiprole versus cephalosporin.\ Only one trial reported our primary outcomes of death from all causes and serious adverse events (major complications). Three trials reported our secondary outcome of treatment failure. Two trials primarily included community‐acquired pneumonia and hospitalised children with bacterial infections, hence the children with hospital‐acquired pneumonia constituted only subgroups of the total study populations.\ Where outcomes were reported, the certainty of the evidence was very low for each of the comparisons. We were unable to draw any meaningful conclusions from the numerical results.\ None of the included trials assessed health‐related quality of life, pneumonia‐related death, or non‐serious adverse events (minor complications).\ Conclusions\ The available evidence does not suggest that one antibiotic regimen is safer and more effective than another in treating newborns and children with hospital‐acquired pneumonia.](https://app.figure1.com/case-detail/83a69634-e2ea-4ac3-be73-c9556fa0e603)

\ \ Review question\ We tried to identify whether there was a difference in the outcomes for children aged 2 to 59 months with non‐severe pneumonia and wheeze, treated with or without antibiotics.\ Background\ Pneumonia is an infection of the lungs. In children, it is one of the leading causes of deaths globally. Pneumonia can be classified according to the World Health Organization (WHO) guidelines. Classification includes assessment of certain clinical signs and symptoms, severity of the disease and its treatment according to the severity. For non‐severe pneumonia, the WHO recommends treatment with oral antibiotics. We used the 2014 WHO definition of non‐severe pneumonia for this review: an acute episode of cough, or difficulty in breathing, combined with fast breathing and chest indrawing.\ More commonly, pneumonia is caused by viruses that require supportive care rather than antibiotic treatment; however, pneumonia caused by bacteria should be treated with antibiotics to avoid complications. Since there is no clear way to quickly distinguish which organism actually caused the pneumonia, it is considered safe to give antibiotics. However, this may lead to the development of antibiotic resistance, and limit their use in future infections. The question is whether the use of antibiotics is justified in non‐severe pneumonia.\ Search date\ Our evidence is current to 23 December 2020.\ Study characteristics\ We included three trials (3256 children). They were conducted in four hospitals in three cities in Pakistan (Islamabad, Lahore and Rawalpindi), and in hospital outpatient departments in India and Malawi. The children were treated with a three‐day course of amoxicillin (antibiotic) or placebo, and followed up for two weeks. One trial is awaiting classification.\ Study funding source\ The included trials were supported by the USAID through INCLEN and IndiaClen; ARI Research Cell, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, and by a grant from the Bill & Melinda Gates Foundation.\ Key results\ Limited data showed a 20% reduction in treatment failure, however, no impact was observed on clinical cure, relapse, and treatment harms. No deaths were reported in either group. Our review did not have enough evidence to support or challenge the continued use of antibiotics for the treatment of non‐severe pneumonia.\ Certainty of the evidence\ The certainty of evidence for clinical cure was moderate. The certainty of evidence for treatment failure, relapse, and treatments harms was low, due to downgrading for imprecision and risk of bias.](https://app.figure1.com/case-detail/90a3093c-b1d8-437e-879b-853cdd46218f)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)