Acute Tonsillitis and Bronchitis in Russian Primary Pediatric Care: Prevailing Antibacterial Treatment Tactics and Their Optimization
American Journal of Pediatrics
Volume 4, Issue 3, September 2018, Pages: 46-51
Received: May 25, 2018;
Accepted: Jun. 27, 2018;
Published: Jul. 26, 2018
Views 1510 Downloads 147
Vladimir Tatochenko, National Medical Research Centre of Child Health, Moscow, Russia
Eugenia Cherkasova, Pulmonology and Allergology Department, S. I. Kruglaya Clinical Research Centre, Oryol, Russia
Tatjana Kuznetsova, Internal Disease Department, Medical College, I. S. Turgenev State University, Oryol, Russia
Diana Sukhorukova, City Pediatric Polyclinic No.4, Medical College, I. S Turgenev State University, Oryol, Russia
Maya Bakradze, Diagnostic Department, National Medical Research Centre of Child Health, Moscow, Russia
Inappropriate use of antibiotics in children with acute tonsillitis (AT) and bronchitis is an important cause of the microbial resistance. The aim of the study was to find out pediatricians’ motives in prescribing antibiotics and the extent of their inappropriate use in these cases, as well as maternal attitudes to the use of antibiotics in acute viral respiratory infections (ARI). We also studied in the context of regular primary pediatric care the acceptability to parents of a judicious use of antibiotics. Pediatricians (n=97) attitudes to antibiotics and their practices were studied by a questionnaire in 4 cities of Russia, mothers’ attitudes to antibiotics (n=107) and antibiotic use frequencies were studied in an Oryol polyclinic. Optimization of treatment studies (acute tonsillitis 1577 child-years, acute bronchitis 3303 child-years of observations) were conducted by two co-authors in their capacity of primary pediatric providers (for about a 1000 children each) in a polyclinics of Oryol. Antibiotics were given only to AT cases found positive for hemolytic streptococcus (GABHS) by an express-test. Patients with acute bronchitis and bronchiolitis were treated by inhalation of 0.9% or 3% saline solutions. Most (95-100%) pediatricians consider tonsillitis (without bacteriological evidence obtained at the point of care) to be of bacterial origin and treat it with antibiotics - for the fear of GABHS complications, self-protection or as a traditions. About a half of mothers would add antibiotics to whatever else pediatrician prescribes for ARI, 1/3 mothers prefer self-treatment with antibiotics if body temperature is over 38°C. Of tonsillitis patients 80.5% and of bronchitis over 70% - are treated in the outpatient setting with antibiotics. The incidence of tonsillitis was 80 per 1000 children of all ages, the proportion of GABHS-tonsillitis - 27% - only in children above 4 years of age (population incidence 7.5 per 1000). 87% of mothers of GABHS negative children accepted treatment without antibiotics. Similarly, 88.5% of parents of children with bronchiolitis (incidence 113 per 1000 0-2 years old) and acute bronchitis (61 per 1000 0-18 years old) agreed to use only saline inhalations. We conclude that additional attention to mothers (explaining results of the express-test, or teaching how to do inhalation) overcome their fears of withholding antibiotics.
Acute Tonsillitis and Bronchitis in Russian Primary Pediatric Care: Prevailing Antibacterial Treatment Tactics and Their Optimization, American Journal of Pediatrics.
Vol. 4, No. 3,
2018, pp. 46-51.
Sabuncu E, David J, Bernède-Bauduin C, Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Med. 2009 Jun 2; 6(6):e1000084.
Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. Eur Arch Otorhinolaryngol. 2016; 273(4):973-87.
McCullough AR1, Pollack AJ2, Plejdrup Hansen M3, Glasziou PP4, Looke DF5, Britt HC6, Del Mar CB. Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations. Med J Aust. 2017; 17; 207 (2):65-69.
А. А. Baranov, V. Tatochenko, M. Bakradze (editors). The child with fever. Protocols of diagnosis and treatvment. 3d ed. Moscow, Pediatr, 2017.
NICE. Respiratory tract infections—antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Clinical Guideline 69, 2008.
Ivanovska V, Hek K, Mantel Teeuwisse AK, Leufkens H, Nielen M, van Dijk L. " Antibiotic prescribing for children in primary care and adherence to treatment guidelines" J. Antimicrob Chemother. 2016 Jun; 71 (6):1707-14.
Ghosh R, Rossner P, Honkova K, Dostal M, Sram RJ, Hertz-Picciotto I. Air pollution and childhood bronchitis: Interaction with xenobiotic, immune regulatory and DNA repair genes. Environ Int. 2016; 87: 94-100.
Tatochenko V. K. Diseases of respiratory organs in children (new ed). Moscow, Pediatr 2015. – 395 p.
Kuchar E, Miśkiewicz K, Szenborn L, Kurpas D Adv Exp Med Biol. Respiratory tract infections in children in primary healthcare in Poland. 2015; 835: 53-9.
Gardiner SJ, Gavranich JB, Chang AB. Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children. Cochrane Database Syst Rev. 2015 Jan 8.
Farley R, Spurling GKP, Eriksson L, Del Mar CB: Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014 Oct 9;(10).
Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the infectious diseases society of America. Clin Infect Dis. 2012; 55 (10):1279–1282.
Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014; 134 (5):e1474–502.
Hersh AL Shapiro DJ, Pavia AT, Shah SS.. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011; 128 (6): 1053-61.
Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM Jr et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016; 315(17): 1864-73.
Zhukova O. V., Kononova S. V., Konyshkina T. M. [Distribution of expenditures to pharmacotherapy of acute obstructive bronchitis in children under the practical clinical conditions. A pharmacoeconomic study – Rus,]. Farmateka, Moscow). 2011; 18 (231): 63-67.
Kulitchenko T. V., Baibarina E. N., Baranov A. A., Namazova-Baranova L. S. Piskunova S. G., Besedina E. A., et al. [Audit of pediatric hospital services in the regions of Russian Federation – Rus] Vestnik RAMN. 2016. NO 71 (3). 214–223.
Darmanjan A. S. [Practical use of modern diagnostic methods of the streptococcal infection – Rus.]Pediatric pharmmacology. 2013; 10 (5): 97–100.
E. Cherkasova, T. Kuznetsova. [Analysis of antibacterial treatment tactics of acute tonsillitis in children based on a questionnaire survey Russ. pediatric J. 2015; 18(5): 4-5.
Mandelberg A, Amirav I.; Hypertonic saline or high volume normal saline for viral bronchiolitis: mechanisms and rationale; Pediatr Pulmonol; 2010; NO 45: 36-40.
McIsaac W. J. et al. Empirical validation of guidelines for the management of pharyngitis in children and adults// JAMA/ 2004; 291: 1587-95.
Sukhorukova DN, Kuznetsova TA. [The treatment of an acute bronchiolitis in children in the context of a district covered by child health care.] Russ. pediatric J. 2017; 20(5): 329-333.
Dronov I, A., Geppe N. A. MalakhovА. B., Kondjurina E, G, m Tatarenko U. A., Tjuteva E, J., Michalev E. V. [Knowledge of pediatricians about antibacterial therapy – the fi rst results of a interregional study]. Pediatric gastroenterology 2014; 11: 14-18.