Objective. To estimate the iatrogenic costs of nonsteroidal antiinflammatory drug (NSAID) treatment from the perspective of the Italian National Health Service. Methods. We conducted a retrospective cohort study using the primary and secondary care claims data registered in the regional health service database in the Friuli-Venezia Giulia (Italy). The study cohort comprised all persons (265,114) who received at least one prescription for any NSAID between August 1996 and July 1998. The outcomes of interest were the costs of medical interventions for upper gastrointestinal disorders following NSAID treatment (i.e., prescriptions for gastroprotective drugs, hospitalizations, and outpatient diagnostic procedures). Results. The study population received a total of 660,311 NSAID prescriptions for a cost of 6,587,533 Euros (€) (€0.53 per treatment day). The cost of medical interventions for gastrointestinal events added 58% to the cost of NSAID therapy (€0.31 per NSAID treatment day, up to 64% directly attributable to NSAID use). The iatrogenic costs were generated by 12.4% of the patients, 77% of whom had a positive history of gastrointestinal disorders and 82% of whom were older than 50 years. Co-prescriptions for gastroprotective drugs accounted for 78.6% of the overall iatrogenic costs. The iatrogenic costs did not differ between cyclooxygenase (COX) nonselective and COX-2 preferential drugs within strata of age and prior history of gastrointestinal disorders, but were significantly higher for the parenteral NSAIDs than the oral or rectal formulations. Conclusions. In Italy, the iatrogenic costs of NSAID therapy add 58% to the cost of NSAID treatment; most of the cost is generated by co-prescriptions of gastroprotective drugs to elderly NSAID users or patients with a history of gastrointestinal disorders.
Comprehensive information on prescription patterns of antibiotics in Italy is scarce. This study describes the use of systemic antibiotics in children according to age and sex in Friuli Venezia Giulia, north‐east Italy. A pharmacological prescription database was used to identify individual prescriptions provided to all 0–15‐y‐old resident children (n= 140630) during 1998. Overall, 124 383 prescriptions were identified. The prescription rate was highest in the 3‐6 y olds, with 1491 antibiotic prescriptions per 1000 children per year. Antibiotics were prescribed for 52% of infants, 57.2% of toddlers and 62% of preschool children. Twenty‐nine percent of the prescriptions were for cephalosporins, 27% for macrolides and 24% for broad‐spectrum penicillins. Prescription rates were much higher than in other countries such as Denmark, with more antibiotic courses prescribed for more children at all ages. Prescriptions from general practitioners and family paediatricians often included second‐line antibiotics (e.g. cephalosporins and macrolides) or antibiotics that have not been approved for community‐acquired paediatric infections (e.g. quinolones). Conclusion: The development of regional guidelines for antibiotic use in children should be urgently recommended.
To differentiate bacterial from viral infections the level of C-reactive protein in serum samples was studied in three groups of children under 5 years of age with gastroenteritis. Of the 53 children with bacterial infection, 41 (77%) had C-reactive protein levels > or = 12 mg1 -1, 32 (66%) > or = 20 mgl-1 and 24 (45%) > or = 35 mgl-1. Of the 35 patients with viral infection, 4 (11%) had C-reactive protein levels > or = 12 mgl-1, 3 (9%) > or = 20 mgl-1 and 1 (3%) > or = 35 mgl-1. The best balance between sensitivity and specificity of C-reactive protein was obtained for a cut-off level > or = 12 mgl-1 (sensitivity 77%, specificity 89%) as compared to > or = 20 mgl-1 (sensitivity 58%, specificity 97%) and > or = 35 mgl-1 (sensitivity 44%, specificity 97%). Our results suggest that the determination of C-reactive protein values may be a useful tool for predicting bacterial gastroenteritis in children.
A case‐control study of 85 cases with non‐typhoid Salmonella gastroenteritis, 85 outpatient controls and 79 inpatient controls was conducted among children in Monfalcone, north‐east Italy, between June 1989 and June 1994. Logistic regression was used to evaluate the effect of demographic and socioeconomic characteristics, duration of breastfeeding, history of intestinal illnesses and household diarrhoea, and the recent use of antimicrobials. Breastfeeding was the single most important factor associated with a 5‐fold decreased risk of Salmonella infection. In addition, children who were treated with antimicrobials before onset of gastroenteritis had a 3‐fold increased risk. Low social class and history of other chronic non‐infectious intestinal diseases were also directly associated with illness.
An outbreak of louse-borne relapsing fever, caused by the return to their original recruitment areas of soldiers at the end of 30 years of fighting in northern Ethiopia, was reported in the Arsi region. We studied 103 infants and children with louse-borne relapsing fever who were admitted to Asella Hospital between 1 May 1991 and 30 April 1992. Twenty-one per cent of the patients had a clear history of contact with sick ex-soldiers; 42% were students admitted to the hospital following the re-opening of schools after the summer vacation. The common clinical features of the disease were fever in 100%, headache in 84.5%, chills in 74%, abdominal pain in 51%, epistaxis in 20%, hepatomegaly in 26%, splenomegaly in 14%, petechial rash in 34% and jaundice in 10%. Differences in symptoms and signs according to age are described. Observed complications were pneumonia in 14% and central nervous system involvement in 10%. Four children went into deep coma, and two of them died. Severe disease was associated with a high density of spirochaetes in blood smears. Patients were treated with two low doses of penicillin or one dose of penicillin followed by, according to age, chloramphenicol or tetracycline, and with intravenous fluids. The case fatality rate was 1.9%. Jarisch-Herxheimer reactions occurred in 61% of patients. There were relapses in 2.9% of treated patients.
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