Predictors of Non-adherence to iron chelation therapy in pediatric thalassemia patients

Objective: This study was conducted to identify predictors of non-adherence to iron chelation therapy among children suffering from β-thalassemia major across different treatment regimens. Materials and Methods: It was a cross-sectional study carried out from 1st January 2019 to 30th June 2019. The study was conducted at the Pakistan Institute of Thalassemia, Islamabad. Children between the ages of 2 -16 years suffering from β-Thalassemia major and taking iron chelation therapy were included in the study. Chelation adherence for this analysis was defined as the percent of doses taken in the last 12 weeks out of those prescribed. Guardians of patients were interviewed using a questionnaire and medical records were checked. Data were analysed using SPSS 20.0. Multivariate analysis was conducted to identify the predictors for non-adherence to chelation therapy. The significant value was set at ≤ 0.05. Results: Mean age of the patients in our study was 8.90± 3.74 years. There were 33 males and 64 females. Most of the patients n=87 (89.7%) were taking oral iron chelation therapy. The mean score for chelation adherence was 67.12%. Among the multiple demographic, medical-related, and patient-related factors analysed, travel time from the patient’s residence to the treatment centre and the number of transfusions per year were found to be significant predictors (p-value ≤0.05) of non-adherence to iron chelation therapy. Conclusion: Overall, the study provides strong evidence that healthcare-related factors play a major role in patients’ adherence to treatment. A systemic approach should be taken to ensure patient adherence during the management of paediatric thalassemic patients

Antibiotic Sensitivity Patterns of Uropathogens in Children: The Current Trend

Background: The emergence of antibiotic-resistant infections has led to increased health care costs and mortality among children. The purpose of this study was to determine the causative organisms responsible for urinary tract infection and their antibiotic sensitivity pattern among pediatric patients of Rawalpindi/Islamabad. Material and Methods: This cross-sectional study was carried out from June 2014 to June 2015, in the Department of Microbiology, Army Medical College, Rawalpindi, affiliated with the Military Hospital, Rawalpindi. About 270 urine samples of children with UTI were analyzed through Analytical Profile Index (API) 20E and biochemical test strips system. Their antibiotic susceptibility was determined by using standard techniques. Data were assessed and analyzed by SPSS version 17. Results: Most common uropathogen was Escherichia coli (61.48%), followed by Proteus (15.5), Klebsiella (12.3%), Pseudomonas (4.5%), Enterococcus (3.7%) and Enterobacter (2.5%). Gram-negative rods, were most sensitive to imipenem (100%), Gentamycin (86%) and Amikacin (78.3%). They were least sensitive to Ampicillin (4.2%) and Norfloxacin (5.5%). Gram-positive cocci showed highest sensitivity for Vancomycin (100%) while displayed relatively less sensitivity for Nitrofurantoin (61.2%) and Gentamycin (48.7%). Cephalosporins also showed increased resistance with only 14% of gram-negative rods showing sensitivity to Cefotaxime. These organisms were highly resistant to Penicillin, showing a sensitivity of only 12.4%. Conclusion: Decreased sensitivity against penicillin and cephalosporins is seen in uropathogens causing UTI in children. High sensitivity towards Nitrofurantoin makes this drug an empirical treatment in UTI.  Regular surveillance of the developing resistance in uropathogens due to inappropriate use of antibiotic is necessary to reduce complication in children with urinary tract infection