Utilização de Antimicrobianos para o Tratamento de Infecções Respiratórias em Crianças Atendidas em uma Instituição de Saúde do Estado de Minas Gerais/Use of Antimicrobials for the Treatment of Respiratory Infections in Children Assisted in Health Institu

Pacheco, Alexandre José; Souza, Rafaela de Paula; Prado, Tânia Carla de Moraes; Garcia, José Antônio Dias; Loyola, Yolanda Christina de Sousa

doi:10.21876/rcsfmit.v1i3.58

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“…Studies in Brazil have shown that in most cases there is no standardized protocol for the management of acute respiratory infections, which suggests that the quality of care for a child with acute respiratory infection can be improved through an increase in training and supervision of health care professionals, raising their awareness of the abusive and negligent use of antibiotics. 19 – 21 Studies that assess the prescription of antibiotics within the health care service networks are useful to detect preventable inadequacies in the care of children with pneumonia. 1 , 22 …”

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confidence: 99%

Prescription of antibiotics in community-acquired pneumonia in children: are we following the recommendations?

Lima¹,

Lima²,

Serra³

et al. 2016

TCRM

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ObjectiveTo assess the adequacy of antibiotic prescription in children hospitalized for pneumonia in a reference pediatric hospital in Brazil.MethodsThis was a cross-sectional study involving children aged between 1 month and 5 years who were hospitalized between October 2010 and September 2013. The classification of community-acquired pneumonia (CAP) was based on the clinical and radiological criteria of the World Health Organization (WHO). The analysis of antibiotic adequacy was performed according to the main guidelines on CAP treatment, which include the WHO guidelines, Brazilian Society of Pediatrics guidelines, and international guidelines (Pediatrics Infectious Diseases Society, the Infectious Disease Society of America, British Thoracic Society, and Consenso de la Sociedad latinoamericana de Infectología). A multivariate analysis was performed including variables that have statistical significance of P≤0.25 in the bivariate analysis.ResultsThe majority of the 452 hospitalized children were classified as having severe or very severe CAP (85.18%), and inadequate empiric antimicrobial therapy was started in 26.10% (118/452) of them. Ampicillin was the most used empiric antibiotic therapy (62.17%) for pneumonia, followed by a combination of ampicillin and associated with gentamicin. The initially proposed regimen was modified in 29.6% of the patients, and the most frequent change was the replacement of ampicillin by oxacillin combined with chloramphenicol. The median hospitalization time was 8.5 days, and the lethality rate was 1.55%. There was no statistical difference in adequacy in relation to the severity of pneumonia or degree of malnutrition. In the bivariate analysis, inadequacy of antibiotic therapy regimen was higher in patients undergoing oxygen therapy (P<0.05), which was given to 219 patients (48.45%). Pleural effusion was observed in 118 patients (26.11%) and was associated with higher prescription inadequacy, and it was the only factor that remained in the multivariate analysis (odds ratio =8.89; 95% confidence interval 5.20–15.01).ConclusionAdherence to the main guidelines for antimicrobial therapy according to the childhood CAP was unsatisfactory. Compliance with the guidelines is essential for both the management of pneumonia cases and the decrease in bacterial resistance and it is one of the cornerstone of WHO police of controlling antibiotic resistance.

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