scholarly journals Antibiotic treatment of diarrhoea is associated with decreased time to the next diarrhoea episode among young children in Vellore, India

2015 ◽  
Vol 44 (3) ◽  
pp. 978-987 ◽  
Author(s):  
Elizabeth T Rogawski ◽  
Daniel J Westreich ◽  
Sylvia Becker-Dreps ◽  
Linda S Adair ◽  
Robert S Sandler ◽  
...  
Keyword(s):  
Young Children ◽  
Antibiotic Treatment ◽  
Diarrhoea Episode

scholarly journals The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

2016 ◽  
Vol 20 (51) ◽  
pp. 1-294 ◽  
Author(s):  
Alastair D Hay ◽  
Kate Birnie ◽  
John Busby ◽  
Brendan Delaney ◽  
Harriet Downing ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Cost Effectiveness ◽  
Tract Infection ◽  
Young Children ◽  
Clinical Diagnosis ◽  
Antibiotic Treatment ◽  
Clinical Judgement ◽  
Index Tests

BackgroundIt is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment.ObjectivesTo develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.DesignMulticentre, prospective diagnostic cohort study.Setting and participantsChildren < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms.MethodsOne hundred and seven clinical characteristics (index tests) were recorded from the child’s past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood (‘clinical diagnosis’) and urine sampling and treatment intentions (‘clinical judgement’) were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 105colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the ‘clinician diagnosis’ AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with ‘clinical judgement’.ResultsA total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, ‘clinical diagnosis’ correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. ‘Clinical diagnosis’ correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut.ConclusionsClinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment

PLoS Medicine ◽  
2013 ◽  
Vol 10 (5) ◽  
pp. e1001421 ◽  
Author(s):  
Harry Campbell ◽  
Shams el Arifeen ◽  
Tabish Hazir ◽  
James O'Kelly ◽  
Jennifer Bryce ◽  
...  
Keyword(s):  
Young Children ◽  
Antibiotic Treatment

scholarly journals Is Empirical antibiotic treatment in UTI justified in resource constraint settings in India

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 245-250
Author(s):  
Balamma Sujatha ◽  
Lal D V ◽  
Sulochana G
Keyword(s):  
Young Children ◽  
Antibiotic Treatment ◽  
Demographic Data ◽  
Kidney Injury ◽  
Community Analysis ◽  
Resource Constraint ◽  
Resistance Pattern ◽  
Community Settings ◽  
Chronic Kidney Injury ◽  
Increased Risk

UTI, one of the most common infections noted in children, is reported with incidence of 2% in boys and 8% in girls of less than 8year. Absence of specific signs of UTI in younger children and increased risk for complications make it almost mandatory to test for UTI in very young children with fever. Fairly common genitourinary tract abnormalities in young children makes it even more important to screen for UTI as it can lead to chronic kidney injury later. Emperic antibiotic treatment in suspected UTI in children is rampant in our community; equally high is the possibility of antibiotic resistance, which is not studied due to cost limitations. Hence the need for identifying the change in microbial flora causing UTI and their changes in resistance pattern at community level, making it an important tool for preventing and addressing the growth issues, complications like CKD, etc. The study aims at addressing this infelt need of the community. Analysis of culture-positive UTI cases referred as suspected UTI from the community for evaluation from April 2017-March 2018 were done. Demographic data, organisms, their susceptibility to common antibiotics prescribed in our community settings were analysed. UTI was common in boys between 1-5years. The common organism isolated was E.coli and Enterococcus species, followed by Klebsiella in girls and Proteus in males. Nearly 40% of GNB isolates were ESBL producing organisms with E.coli being highest. 70% of E.coli were resistant to commonly used 1stline antibiotics-Ampicillin and cephalexin. 50% of other isolates were resistant to common antibiotics. This may lead to failure of treatment in UTI, leading to long-term complications. Hence empirical antibiotic therapy is not advised even in resource constraint community settings.

scholarly journals Staphylococcal Epidermolysis: A Case Report

2021 ◽  
pp. 1-5
Author(s):  
Nadia Mebrouk ◽  
Hamza Berrada ◽  
Yamna Kriouile ◽  
Asmaa Mdaghri Alaoui
Keyword(s):  
Case Report ◽  
Young Children ◽  
Skin Biopsy ◽  
Antibiotic Treatment ◽  
Clinical Examination ◽  
Staphylococcal Scalded Skin Syndrome ◽  
Positive Diagnosis ◽  
Fatal Course

Acute staphylococcal epidermolysis, also known as staphylococcal scalded skin syndrome (SSSS), in young children is caused by the release of exfoliative toxins A and B (ETA and/or ETB) from an initial outbreak which can be ear-nose-throat, conjunctival or cutaneous. Staphylococcal scalded skin syndrome is characterized by painful erythroderma, quickly followed by generalized detachment with respect to mucous surfaces, regressing in 2 to 4 days on antibiotics. The positive diagnosis is mainly based on clinical examination and sometimes on skin biopsy. The course of the disease is benign, favored by anti-staphylococcal treatment combined with local care. However, the risk of fatal course is estimated at around 4% in the event of delay in antibiotic treatment. We report the case of an infant with SSSS, diagnosed and treated early with good evolution.

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