Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving: data from a prospective study in a French network

International audienceBACKGROUND: Lower respiratory tract infection is a common cause of consultation and antibiotic prescription in paediatric practice. The misuse of antibiotics is a major cause of the emergence of multidrug-resistant bacteria. The aim of this study was to evaluate the frequency, changes over time, and determinants of non-compliance with antibiotic prescription recommendations for children admitted in paediatric emergency department (PED) with community-acquired pneumonia (CAP).METHODS: We conducted a prospective two-period study using data from the French pneumonia network that included all children with CAP, aged one month to 15 years old, admitted to one of the ten participating paediatric emergency departments. In the first period, data from children included in all ten centres were analysed. In the second period, we analysed children in three centers for which we collected additional data. Two experts assessed compliance with the current French recommendations. Independent determinants of non-compliance were evaluated using a logistic regression model. The frequency of non-compliance was compared between the two periods for the same centres in univariate analysis, after adjustment for confounding factors.RESULTS: A total of 3034 children were included during the first period (from May 2009 to May 2011) and 293 in the second period (from January to July 2012). Median ages were 3.0 years [1.4-5] in the first period and 3.6 years in the second period. The main reasons for non-compliance were the improper use of broad-spectrum antibiotics or combinations of antibiotics. Factors that were independently associated with non-compliance with recommendations were younger age, presence of risk factors for pneumococcal infection, and hospitalization. We also observed significant differences in compliance between the treatment centres during the first period. The frequency of non-compliance significantly decreased from 48 to 18.8 % between 2009 and 2012. The association between period and non-compliance remained statistically significant after adjustment for confounding factors. Amoxicillin was prescribed as the sole therapy significantly more frequently in the second period (71 % vs. 54.2 %, p < 0.001).CONCLUSIONS: We observed a significant increase in the compliance with recommendations, with a reduction in the prescription of broad-spectrum antibiotics, efforts to improve antibiotic prescriptions must continue

Compliance et faisabilité d'une stratégie de prévention de la coqueluche au cours d'une épidémie au sein d'un groupe d'étudiants hospitaliers à l'hôpital Armand Trousseau

Contexte et objectifs. - Un hôpital pédiatrique parisien a dû faire face à des cas groupés de coqueluche parmi ses étudiants hospitaliers en mars 2005. Les mesures préventives recommandées ont été mises en place. La faisabilité et la compliance à ces mesures ont pu être évaluées ainsi que les facteurs qui les ont déterminées. Méthodes. - Les 83 étudiants pris en charge pour la prescription d une prophylaxie par Clarithromycine pour la plupart et d un rappel vaccinal par REPE VAX® lorsque c était possible, ont été revus une première fois au cours d un entretien individuel. La survenue de nouveaux cas parmi ces étudiants ou leur entourage a été recherchée par la prise de nouvelles téléphonique après leur changement de stage. Résultats.-La compliance globale des étudiants a été de 56%. Il est apparue une disparité de compliance d une part entre les externes asymptomatiques chez qui la prophylaxie n a été suivie que par 49% et celle des cas suspects interrogés qui était de 100%, d autre part entre les externes qui avaient eu des contacts ou non avec les premiers cas. La compliance a été dans ce cas respectivement de 67% et de 35%. Les motifs donnés pour le manque d observance étaient le sentiment de n être pas exposé (3 8%), le sentiment que 5 jours d antibioprophylaxie suffisent (31%), la mauvaise tolérance digestive à l antibiotique (19%), le sentiment d être immunisé (8%) et enfin la peur de ressentir les effets indésirables rapportés par les autres déjà traités (4%). Le taux de vaccination chez les sujets dont le dernier rappel dTP avait plus de 5 ans et qui représentaient 39% des étudiants, a été de 41%. La prise de nouvelles n a pas mis en évidence de cas secondaires dans cette population d étudiants mais l existence de cas suspects au sein du reste de leur promotion. Conclusions. - Il a été mis en évidence la difficulté de mise en pratique des mesures de prévention. Une moins bonne compliance a été observée par rapport aux chiffres d autres études. Une prophylaxie par Azythromycine et une amélioration de l information seraient de nature à améliorer la compliance. La vaccination comme prophylaxie paraît difficile à mettre en place.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

PRONOSTIC DES FORMES PROLONGEES ET RECIDIVANTES DE LA MALADIE DE KAWASAKI (ETUDE RETROSPECTIVE (1995-1999) A L'HOPITAL A. TROUSSEAU, PARIS)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Comparaison de l'efficacité de deux antibiothérapies dans la prise en charge initiale aux Urgences Pédiatriques des surinfections cutanées de la varicelle (Etude à propos de 47 cas)

PARIS13-BU Serge Lebovici (930082101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Utilité du ionogramme sanguin dans la prise en charge des gastro-entérites aiguës du nourrisson

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Defining pertussis epidemiology : clinical, microbiologic and serologic perspectives

In the past decade, numerous sources have noted an increase in reported pertussis in highly immunized populations. This has been accompanied by a perceived change in disease epidemiology, characterized by a significant increase in reported pertussis incidence among adolescents and adults. In populations where children are routinely immunized, adolescents and adults now constitute the main source of infection in infants. However, a range of factors makes delineation of these epidemiologic trends difficult. Reported cases of pertussis represent only a fraction of the actual number of Bordetella pertussis symptomatic infections, because underconsulting, underrecognition and underdiagnosis are widespread and are a particular problem in adolescents and adults. Possible explanations for failure to diagnose pertussis include the heterogeneity in pertussis disease expression and low physician awareness and index of suspicion. Consequently defining pertussis from a clinical perspective is difficult, and this is reflected by a lack of consistency between case definitions. Although case definitions for specific circumstances have been established by the World Health Organization and the United States Centers for Disease Control, these are not universally useful, making intercountry comparisons and global evaluation difficult. Less-than-optimal and poorly performed laboratory tests, or their lack of availability, also make confirmation of B. pertussis infection difficult. To overcome these problems, clinical case definitions should be standardized for outbreak and endemic situations. Rapid, easy-to-use and inexpensive laboratory diagnostic techniques also must be made available and be widely implemented. In particular, polymerase chain reaction and single serum serology are 2 techniques that should be more widely adopted