Young Zambian infants with symptomatic RSV and pertussis infections are frequently prescribed inappropriate antibiotics: a retrospective analysis.
Young Zambian infants with symptomatic RSV and pertussis infections are frequently prescribed inappropriate antibiotics: a retrospective analysis.
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作者：
Gunning CE;Rohani P;Mwananyanda L;Kwenda G;Mupila Z;Gill CJ
儿科社区获得性肺炎（CAP）仍然是一个紧迫的全球卫生问题，特别是在资源匮乏的环境中，诊断和治疗依赖于经验和基于症状的指南，如世卫组织的儿童疾病综合管理（IMCI）。本研究详细介绍了2015年在赞比亚卢萨卡一个资源匮乏的城市社区为1320名婴儿及其母亲提供的基于儿童综合健康指数的卫生保健服务。我们的南非母婴百日咳研究（SAMIPS）前瞻性地监测了一组母亲/婴儿在婴儿出生后的前四个月，记录了呼吸道感染的症状和抗生素处方（主要是青霉素），并检测了鼻咽（NP）样本中呼吸道合胞病毒（RSV）和百日咳博德泰拉。我们对SAMIPS队列的回顾性分析发现，症状和抗生素使用在婴儿（43%和15.7%）中比在母亲（16.6%和8%）中更常见，而在婴儿（2.7%和32.5%）和母亲（2%和35.5%）中观察到RSV和百日咳的发生率相似，尽管经常是非常低的水平。在婴儿中，我们观察到症状、病原体检测和抗生素使用之间存在很强的相关性。关键的是，我们证明了非大环内酯类抗生素通常用于百日咳感染，其中一些持续了许多周。我们推测，提高诊断特异性和/或临床医生教育，配合及时、适当的百日咳治疗，可以大大减轻该病的负担，同时减少青霉素的脱靶使用。
Pediatric community-acquired pneumonia (CAP) remains a pressing global health concern, particularly in low-resource settings where diagnosis and treatment rely on empiric, symptoms-based guidelines such as the WHO’s Integrated Management of Childhood Illness (IMCI). This study details the delivery of IMCI-based health care to 1,320 young infants and their mothers in a low-resource urban community in Lusaka, Zambia during 2015. Our Southern Africa Mother Infant Pertussis Study (SAMIPS) prospectively monitored a cohort of mother/infant pairs across infants’ first four months of life, recording symptoms of respiratory infection and antibiotics prescriptions (predominantly penicillins), and tested nasopharyngeal (NP) samples for respiratory syncytial virus (RSV) and Bordetella pertussis. Our retrospective analysis of the SAMIPS cohort found that symptoms and antibiotics use were more common in infants (43% and 15.7%) than in mothers (16.6% and 8%), while RSV and B. pertussis were observed at similar rates in infants (2.7% and 32.5%) and mothers (2% and 35.5%), albeit frequently at very low levels. In infants, we observed strong associations between symptoms, pathogen detection, and antibiotics use. Critically, we demonstrate that non-macrolide antibiotics were commonly prescribed for pertussis infections, some of which persisted across many weeks. We speculate that improved diagnostic specificity and/or clinician education paired with timely, appropriate treatment of pertussis could substantially reduce the burden of this disease while reducing the off-target use of penicillins.
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影响因子：
11.8
作者：
Li, Lijun;Deng, Jikui;Yao, Kaihu
通讯作者：
Yao, Kaihu
影响因子：
7.7
作者：
Gill CJ;Gunning CE;MacLeod WB;Mwananyanda L;Thea DM;Pieciak RC;Kwenda G;Mupila Z;Rohani P
通讯作者：
Rohani P
影响因子：
11.8
作者：
Kamachi K;Duong HT;Dang AD;Hai T;Do D;Koide K;Otsuka N;Shibayama K;Hoang HTT
通讯作者：
Hoang HTT
DOI：
10.1177/0042098020910873
发表时间：
2020-03-31
期刊：
Urban Studies (Edinburgh, Scotland)
影响因子：
--
作者：
Connolly C;Keil R;Ali SH
通讯作者：
Ali SH
DOI：
10.1098/rspb.2015.2309
发表时间：
2016-01-13
影响因子：
4.7
作者：
de Celles, Matthieu Domenech;Magpantay, Felicia M. G.;Rohani, Pejman
通讯作者：
Rohani, Pejman