Antibiotic prescription for febrile children in European emergency departments: a cross-sectional, observational study

Maat, Josephine van de; Voort, Elles van de; Mintegi, Santiago; Gervaix, Alain; Nieboer, Daan; Oostenbrink, Rianne; Moll, Henriëtte A.; Veen, Mirjam van; Noordzij, Jeroen G.; Smit, Frank J; Wermeskerken, Anne-Marie van; Angoulvant, François; Dubos, François; Gras-Leguen, Christèle; Desmarest, Marie; Aurel, M.; Gajdos, Vincent; Joffre, Christelle; Acedo, Yordana; Garcia, Laura Herrero; Medina, Inmaculada; Cózar, Juan Alonso; Arribas, José Luis Fernández; Pinto, Sara; Sá, Gabriela Araújo e; Mação, Patrícia; Silva, Daniela; Zarcos, Maria; Seiler, Michelle; Maconochie, Ian; Olesen, Hanne Vebert; Bønnelykke, Christiane; Parri, Niccolò; Fichera, Vito; Arrhigini, Alberto; Bressan, Silvia; Dalt, Liviana Da; Moldovan, D; Dreghiciu, Daniela-Maria; Bognár, Zsolt; Yılmaz, Hayri Levent; Gökay, Sinem Sarı

doi:10.1016/s1473-3099(18)30672-8

Cited by 48 publications

(60 citation statements)

References 25 publications

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“…Our observed 30% antibiotic prescription rate at baseline for suspected lower RTIs is lower than what has been described in other European EDs, where antibiotic prescription rates range from 52% to 78% [5,6,13,32]. Even though the populations in many studies cannot be directly compared, a recent paper showed that after adjustment for differences in population, large variability in antibiotic prescription remains [1]. We expect that the effect of our intervention on antibiotic prescription may therefore be larger in settings with a higher baseline prescription rate, or in populations with a larger proportion of low-risk children.…”

Section: Discussioncontrasting

confidence: 71%

“…Respiratory tract infections (RTIs) are the most common diagnosis in febrile children, and the most common reason for antibiotic prescription in children [1]. In children under 5 years, most lower RTIs are viral [2].…”

Section: Introductionmentioning

confidence: 99%

“…Although mortality caused by lower RTIs has decreased significantly over the past decades (currently 1.7 per 100,000 people in Western Europe) [3], antimicrobial resistance due to unnecessary antibiotic prescription is increasing [4]. High variability in antibiotic prescription in children with RTIs in primary as well as hospital care throughout Europe highlights the need for better targeting of antibiotic prescriptions in this patient group [1,5,6]. One of the main challenges when attempting to safely reduce antibiotic prescriptions for lower RTIs in children is the absence of a gold standard for the diagnosis of bacterial pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial

Maat

Peeters²,

Nieboer

et al. 2020

PLoS Med

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Background Optimising the use of antibiotics is a key component of antibiotic stewardship. Respiratory tract infections (RTIs) are the most common reason for antibiotic prescription in children, even though most of these infections in children under 5 years are viral. This study aims to safely reduce antibiotic prescriptions in children under 5 years with suspected lower RTI at the emergency department (ED), by implementing a clinical decision rule. Methods and findings In a stepped-wedge cluster randomised trial, we included children aged 1-60 months presenting with fever and cough or dyspnoea to 8 EDs in The Netherlands. The EDs were of varying sizes, from diverse geographic and demographic regions, and of different hospital types (tertiary versus general). In the pre-intervention phase, children received usual care, according to the Dutch and NICE guidelines for febrile children. During the intervention phase, a validated clinical prediction model (Feverkidstool) including clinical characteristics and C-reactive protein (CRP) was implemented as a decision rule guiding antibiotic prescription. The intervention was that antibiotics were withheld in children with a low or intermediate predicted risk of bacterial pneumonia (�10%, based on Feverkidstool). Co-primary outcomes were antibiotic prescription rate and strategy failure. Strategy failure was defined

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Section: Discussioncontrasting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial

Maat

Peeters²,

Nieboer

et al. 2020

PLoS Med

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“…Data collection took place between October 2014 and February 2016 within the network of Research in European Pediatric Emergency Medicine (REPEM). Detailed methods have been published earlier [19]. In short, all participating 28 EDs recorded medical information for all attending children with fever for one random day each month.…”

Section: Data Collectionmentioning

confidence: 99%

“…Table 1 shows their baseline characteristics and provides information regarding patients' way of referral and follow-up. Baseline characteristics of children with comorbidities have been published earlier [19]. In general, these children were more ill and older than children without comorbidities.…”

Section: Population Characteristicsmentioning

confidence: 99%

Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe

et al. 2020

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Vital signs can help clinicians identify children at risk of serious illness. The NICE guideline for fever in under-fives recommends a routine measurement of temperature, heart rate, capillary refill and respiratory rate in all febrile children visiting the emergency department (ED). This study aims to evaluate the measurement of paediatric vital signs in European EDs, with specific attention to adherence to this NICE guideline recommendation. In a prospective observational study, we included 4560 febrile children under 16 years from the ED of 28 hospitals in 11 European countries (2014-2016). Hospitals were academic (n = 17), teaching (n = 10) and non-teaching (n = 1) and ranged in annual paediatric ED visits from 2700 to 88,000. Fifty-four percent were male, their median age was 2.4 years (IQR 1.1-4.7). Temperature was measured most frequently (97%), followed by capillary refill (86%), heart rate (73%), saturation (56%) and respiratory rate (51%). In children under five (n = 3505), a complete measurement of the four NICE-recommended vital signs was performed in 48% of patients. Children under 1 year of age, those with an urgent triage level and with respiratory infections had a higher likelihood of undergoing complete measurements. After adjustment for these factors, variability between countries remained.

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Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia

Bielicki

Stöhr

Barratt

et al. 2021

JAMA

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Question: For children with community-acquired pneumonia discharged from an emergency department, observational unit, or inpatient ward (within 48 hours), is subsequent outpatient treatment with oral amoxicillin at a dose of 35-50 mg/kg/day noninferior to 70-90 mg/kg/day, and for 3 days noninferior to 7 days, with regard to the need for antibiotic retreatment? Findings: In this 2x2 factorial randomized clinical trial of 814 children requiring amoxicillin for community-acquired pneumonia at hospital discharge, antibiotic retreatment within 28 days occurred in 12.6% vs 12.4% of those randomized to lower vs higher doses, respectively, and in 12.5% vs 12.5% of those randomized to 3-day vs 7-day amoxicillin duration. Both comparisons met the prespecified 8% noninferiority margin.Meaning: Among children with community-acquired pneumonia discharged from an emergency department, observational unit, or inpatient ward, further outpatient treatment with oral amoxicillin at a dose of 35-50 mg/kg/day was noninferior to a dose of 70-90 mg/kg/day and for 3 days was noninferior to 7 days with regard to the need for later antibiotic retreatment.

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Antibiotic prescription for febrile children in European emergency departments: a cross-sectional, observational study

Cited by 48 publications

References 25 publications

Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial

Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial

Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe

Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia

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