Background and objectives
Treatment guidelines do not recommend antibiotic use for acute respiratory infections (ARI), except for streptococcal pharyngitis/tonsillitis and pneumonia. However, antibiotics are prescribed frequently for children with ARI, often in absence of evidence for bacterial infection. The objectives of this study were 1) to assess the appropriateness of antibiotic prescriptions for mild ARI in paediatric outpatients in relation to available guidelines and detected pathogens, 2) to assess antibiotic use on presentation using questionnaires and detection in urine 3) to assess the carriage rates and proportions of resistant intestinal
Enterobacteriaceae
before, during and after consultation.
Materials and methods
Patients were prospectively enrolled in Children’s Hospital 1, Ho Chi Minh City, Vietnam and diagnoses, prescribed therapy and outcome were recorded on first visit and on follow-up after 7 days. Respiratory bacterial and viral pathogens were detected using molecular assays. Antibiotic use before presentation was assessed using questionnaires and urine HPLC. The impact of antibiotic usage on intestinal
Enterobacteriaceae
was assessed with semi-quantitative culture on agar with and without antibiotics on presentation and after 7 and 28 days.
Results
A total of 563 patients were enrolled between February 2009 and February 2010. Antibiotics were prescribed for all except 2 of 563 patients. The majority were 2
nd
and 3
rd
generation oral cephalosporins and amoxicillin with or without clavulanic acid. Respiratory viruses were detected in respiratory specimens of 72.5% of patients. Antibiotic use was considered inappropriate in 90.1% and 67.5%, based on guidelines and detected pathogens, respectively. On presentation parents reported antibiotic use for 22% of patients, 41% of parents did not know and 37% denied antibiotic use. Among these three groups, six commonly used antibiotics were detected with HPLC in patients’ urine in 49%, 40% and 14%, respectively. Temporary selection of 3
rd
generation cephalosporin resistant intestinal
Enterobacteriaceae
during antibiotic use was observed, with co-selection of resistance to aminoglycosides and fluoroquinolones.
Conclusions
We report overuse and overprescription of antibiotics for uncomplicated ARI with selection of resistant intestinal
Enterobacteriaceae
, posing a risk for community transmission and persistence in a setting of a highly granular healthcare system and unrestricted access to antibiotics through private pharmacies.
Registration
This study was registered at the International Standard Randomised Controlled Trials Number registry under number ISRCTN32862422:
http://www.isrctn.com/ISRCTN32862422
This paper contains descriptions and illustrations of four new species of braconine wasps from two genera Megalommum Szépligeti, 1900 and Nedinoschiza Cameron, 1911 from Vietnam, viz. Megalommum hoabinhense Long, sp. nov., M. simulatum Long, sp. nov., M. sonlaense Long, sp. nov. and Nedinoschiza khuathalinhae Long, sp. nov. Additionally, the genus Megalommum is the first record for Vietnam.
This is the most complete list of Aleiodes species of the subfamily Rogadinae from Vietnam, and of the total seventy five species of this genus reported, sixty three species of the subgenus Aleiodes, five of Arcaleiodes, three of Chelonorhogas, and four species of the genus Heterogamus. There are thirty species newly recorded from the Rogadinae fauna of Vietnam.
The information on valid names, the published papers of the first record of Aleiodes species in Vietnam and the distribution of Aleiodes species were also provided. Additionally, there are three species listed with information about their hosts, being agricultural pests controlled to some degree by these parasitoids.
Two new species of the genus Trispinaria Quicke, 1986, from Vietnam, viz. T. seminigra Long, sp. nov. and T. vietnamica Long, sp. nov., are described and fully illustrated. Additionally, this is the first record of the genus Trispinaria in Vietnam. A checklist with distributions of previously described species of the genus Trispinaria is given. Comparative characters of the Vietnamese species are provided and modified key couplets are provided to facilitate their identification.
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