Antibiotic prescribing practices for acute respiratory illness in children less than 24 months of age in Kenema, Sierra Leone: is it time to move beyond algorithm driven decision making?
Antibiotic prescribing practices for acute respiratory illness in children less than 24 months of age in Kenema, Sierra Leone: is it time to move beyond algorithm driven decision making?
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DOI：
10.1186/s12879-023-08606-0
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发表时间：
2023-09-25
影响因子：
3.7
通讯作者：
Samuels, Robert J.
中科院分区：
文献类型：
--
作者：
Moon, Troy D.;Sumah, Ibrahim;Amorim, Gustavo;Alhasan, Foday;Howard, Leigh M.;Myers, Harriett;Green, Ann F.;Grant, Donald S.;Schieffelin, John S.;Samuels, Robert J.
下呼吸道感染是全球幼儿死亡的主要原因。在许多资源有限的环境中，临床医生依赖于IMCI或ETAT +等指南，这些指南促进了经验性抗生素的使用，以管理急性呼吸道疾病（ARI）。对这两个指南的大量评估显示出总体积极的反应，但也报告了一些挑战，包括过度处方不必要的抗生素的可能性。本研究的目的是描述塞拉利昂东部省凯内马政府医院（KGH）收治的24个月以下有ARI症状的儿童的抗生素处方实践，并确定因ARI住院的儿童经验性处方抗生素的数量，以及他们的临床体征、症状和结局。我们对2020年10月1日至2022年5月31日期间因呼吸道症状入住KGH儿科病房的< 24个月的儿童进行了前瞻性研究。研究护士收集了人口统计学信息、病史和用药史以及住院期间的临床病程信息。共有777名儿童参加。在到达医院之前，224名儿童（28.8%）报告服用抗生素治疗这种疾病，但没有改善。只有15名（1.9%）儿童接受了胸部X线检查以帮助诊断，100%的患者在住院期间接受了抗生素治疗。尽管挽救了生命，但依赖IMCI和ETAT +等临床决策支持工具治疗儿科ARI可能会导致抗生素的过度处方。需要更多地采用实施研究，以制定旨在优化LMIC环境中ARI抗生素使用的策略和工具。此外，需要更加优先考虑确保临床医生拥有临床诊断的基本工具，以及对基本实验室和放射学诊断的更多投资，以帮助LMIC临床医生超越对基于算法的临床决策的唯一依赖。
Lower respiratory tract infections are the leading cause of mortality in young children globally. In many resource-limited settings clinicians rely on guidelines such as IMCI or ETAT + that promote empiric antibiotic utilization for management of acute respiratory illness (ARI). Numerous evaluations of both guidelines have shown an overall positive response however, several challenges have also been reported, including the potential for over-prescribing of unnecessary antibiotics. The aims of this study were to describe the antibiotic prescribing practices for children less than 24 months of age with symptoms of ARI, that were admitted to Kenema Government Hospital (KGH) in the Eastern Province of Sierra Leone, and to identify the number of children empirically prescribed antibiotics who were admitted to hospital with ARI, as well as their clinical signs, symptoms, and outcomes. We conducted a prospective study of children < 24 months of age admitted to the KGH pediatric ward with respiratory symptoms between October 1, 2020 and May 31, 2022. Study nurses collected data on demographic information, medical and medication history, and information on clinical course while hospitalized. A total of 777 children were enrolled. Prior to arrival at the hospital, 224 children (28.8%) reported taking an antibiotic for this illness without improvement. Only 15 (1.9%) children received a chest radiograph to aid in diagnosis and 100% of patients were placed on antibiotics during their hospital stay. Despite the lives saved, reliance on clinical decision-support tools such as IMCI and ETAT + for pediatric ARI, is resulting in the likely over-prescribing of antibiotics. Greater uptake of implementation research is needed to develop strategies and tools designed to optimize antibiotic use for ARI in LMIC settings. Additionally, much greater priority needs to be given to ensuring clinicians have the basic tools for clinical diagnosis, as well as greater investments in essential laboratory and radiographic diagnostics that help LMIC clinicians move beyond the sole reliance on algorithm based clinical decision making.
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