Antibiotic Prescriptions and Prophylaxis in Italian Children. Is It Time to Change? Data from the ARPEC Project.

BACKGROUND: Antimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children's hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions. METHODS: A 1-day PPS on antibiotic use in hospitalized neonates and children was performed in Italy between October and December 2012 as part of the Antibiotic Resistance and Prescribing in European Children project (ARPEC). Seven institutions in seven Italian cities were involved. The survey included all admitted patients less than 18 years of age present in the ward at 8:00 am on the day of the survey, who had at least one on-going antibiotic prescription. For all patients data about age, weight, underlying disease, antimicrobial agent, dose and indication for treatment were collected. RESULTS: The PPS was performed in 61 wards within 7 Italian institutions. A total of 899 patients were eligible and 349 (38.9%) had an on-going prescription for one or more antibiotics, with variable rates among the hospitals (25.7% - 53.8%). We describe antibiotic prescriptions separately in neonates ( = 30 days to <18 years old). In the neonatal cohort, 62.8% received antibiotics for prophylaxis and only 37.2% on those on antibiotics were treated for infection. Penicillins and aminoglycosides were the most prescribed antibiotic classes. In the paediatric cohort, 64.4% of patients were receiving antibiotics for treatment of infections and 35.5% for prophylaxis. Third generation cephalosporins and penicillin plus inhibitors were the top two antibiotic classes. The main reason for prescribing antibiotic therapy in children was lower respiratory tract infections (LRTI), followed by febrile neutropenia/fever in oncologic patients, while, in neonates, sepsis was the most common indication for treatment. Focusing on prescriptions for LRTI, 43.3% of patients were treated with 3rd generation cephalosporins, followed by macrolides (26.9%), quinolones (16.4%) and carbapenems (14.9%) and 50.1% of LRTI cases were receiving more than one antibiotic. For neutropenic fever/fever in oncologic patients, the preferred antibiotics were penicillins with inhibitors (47.8%), followed by carbapenems (34.8%), aminoglycosides (26.1%) and glycopeptides (26.1%). Overall, the 60.9% of patients were treated with a combination therapy. CONCLUSIONS: Our study provides insight on the Italian situation in terms of antibiotic prescriptions in hospitalized neonates and children. An over-use of third generation cephalosporins both for prophylaxis and treatment was the most worrisome finding. A misuse and abuse of carbapenems and quinolones was also noted. Antibiotic stewardship programs should immediately identify feasible targets to monitor and modify the prescription patterns in children's hospital, also considering the continuous and alarming emergence of MDR bacteria

Vaccinazione anti-rotavirus: Intervento lodevole ma... fa risparmiare il sistema sanitario nazionale? L'esperienza del Brasile

The present "budget impact" study assessed the family and health system costs due to diarrhoea in children < 2 years old, before/after the introduction of a rotavirus vaccine in Brazil in 2006. This kind of evaluations plays a crucial role in the assessment of a health intervention and may help reimbursement decision. This is important especially in Countries with low children's diarrhoea mortality and high morbidity. In these settings the vaccine is mainly introduced to contain the health and economic burden more than to reduce deaths. The study was made possible by an international collaboration involving the University of Pisa (Italy), the Liverpool School of Tropical Medicine (UK) and the Federal University of Sergipe (Brazil). Information on diarrhoea health care costs and morbidity was obtained from the primary health care system, the National Public Health database (2004-2008) and care-givers. Diarrhoea ambulatory consultations and hospitalisations had a declining trend during the entire period, with additional steeper reductions after vaccine introduction. Therefore, the vaccine was associated with reduced diarrhoea consultations and hospitalization costs and families' out-of-pocket expenses. Despite these gains, the overall health system costs have increased

Acute Febrile Cholestatic Jaundice in Children: Keep in Mind Kawasaki Disease.

Kawasaki disease (KD) is characterized by persistent fever in addition to four of five signs of mucocutaneous inflammation. Although gastrointestinal involvement does not belong to the classic diagnostic criteria, it has been often associated with KD onset. We reviewed all those patients who were admitted for febrile cholestatic jaundice between 2003 and 2010 in two tertiary pediatric care centres. We found that KD was the second most frequent cause (21%) after viral infections. We also briefly described the clinical presentation of those patients affected by KD and presented with acute febrile jaundice. Considering the relative high frequency of this condition a high index of suspicion of KD should be maintained in patients presenting with febrile cholestatic jaundice

Acute Febrile Cholestatic Jaundice in Children: Keep in Mind Kawasaki Disease

Kawasaki disease (KD) is characterized by persistent fever in addition to four of five signs of mucocutaneous inflammation. Although gastrointestinal involvement does not belong to the classic diagnostic criteria, it has been often associated with KD onset. We reviewed all those patients who were admitted for febrile cholestatic jaundice between 2003 and 2010 in two tertiary pediatric care centres. We found that KD was the second most frequent cause (21%) after viral infections. We also briefly described the clinical presentation of those patients affected by KD and presented with acute febrile jaundice. Considering the relative high frequency of this condition a high index of suspicion of KD should be maintained in patients presenting with febrile cholestatic jaundice

Retrospective Evaluation of the Incidence of Acute Gastroenteritis and Rotavirus Gastroenteritis in Italy

Introduction Acute gastroenteritis (AGE) is one of the most important causes of morbidity and mortality in childhood. Among all the causative agents of AGE, rotavirus (RV) is the most common pathogen. The aim of this study is to estimate the incidence by age group of rotavirus gastroenteritis (RVGE) in children <5 years of age seen at primary care level. This estimation relies on a specifically developed statistical model applied on AGE data reported in the Pedianet database. Materials and Methods This was an observational, retrospective, cohort study using the Pedianet database that included all children aged 12 years with a diagnosis of AGE or acute diarrhea, and registered on the network during the period from January 2002 to December 2008. Since development of the model was specifically based on data collected during the Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in Public Health and Society Study (REVEAL study), RVGE estimation was restricted to children aged <60 months who experienced an AGE. Results A total of 128,154 children <12 years of age were registered on the Pedianet database during the study period by 83 family pediatricians (FPs). Information on 36,679 episodes of AGE between 2002 and 2008 was collected. Of overall 36,679 AGE cases, 24,275 (66.2%) occurred in children <5 years of age. For children <5 years of age, more than half the episodes of AGE occurred in children between 12 and 35 months. Number of RVGE predicted by the model ranged from 2,864 to 4,700 cases, allowing for the estimated underreporting as calculated from the patients participating both in the REVEAL study and included in Pedianet. As expected, the highest rate occurred from November to May, whereas a lower incidence was reported during the summer season from June to September. Conclusions The Pedianet database was found to be a useful instrument for collecting information about the number and main features of AGE episodes at the primary care level in Italy. The statistical model presented in this study has proved reliable to predict RV-positive cases. Epidemiological results showed a consistent RVGE incidence from year to year in children less than 5 years old at the primary care level and underlined the persistent contribution of RV infections to the winter workload of Italian FPs