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Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study

PloS one, 2020-11, Vol.15 (11), p.e0241760 [Peer Reviewed Journal]

COPYRIGHT 2020 Public Library of Science ;COPYRIGHT 2020 Public Library of Science ;2020 Minh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;2020 Minh et al 2020 Minh et al ;ISSN: 1932-6203 ;EISSN: 1932-6203 ;DOI: 10.1371/journal.pone.0241760 ;PMID: 33147269

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Title:
Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study
Author: Minh, Ngo Ngoc Quang ; Toi, Pham Van ; Qui, Le Minh ; Tinh, Le Binh Bao ; Ngoc, Nguyen Thi ; Kim, Le Thi Ngoc ; Uyen, Nguyen Hanh ; Hang, Vu Thi Ty ; Chinh B'Krong, Nguyen Thi Thuy ; Tham, Nguyen Thi ; Khoa, Thai Dang ; Khuong, Huynh Duy ; Vi, Pham Quynh ; Phuc, Nguyen Ngoc Hong ; Vien, Le Thi Minh ; Pouplin, Thomas ; Khanh, Doan Van ; Phuong, Pham Nguyen ; Lam, Phung Khanh ; Wertheim, Heiman F L ; Campbell, James I ; Baker, Stephen ; Parry, Christopher M ; Bryant, Juliet E ; Schultsz, Constance ; Hung, Nguyen Thanh ; de Jong, Menno D ; van Doorn, H Rogier
Foster, Jane
Subjects: Aminoglycosides ; Amoxicillin ; Amoxicillin - pharmacology ; Amoxicillin - therapeutic use ; Amoxicillin - urine ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Anti-Bacterial Agents - urine ; Antibiotics ; Antimicrobial agents ; Bacterial diseases ; Biology and Life Sciences ; Care and treatment ; Cephalosporins ; Cephalosporins - pharmacology ; Cephalosporins - therapeutic use ; Cephalosporins - urine ; Child ; Child, Preschool ; Children ; Chromatography, High Pressure Liquid ; Clavulanic acid ; Clinical medicine ; Clinical trials ; Diagnosis ; Distribution ; Dosage and administration ; Drug Prescriptions - statistics & numerical data ; Drug resistance ; Drug Resistance, Bacterial ; Drug stores ; Enterobacteriaceae ; Enterobacteriaceae - drug effects ; Enterobacteriaceae - growth & development ; Enterobacteriaceae - isolation & purification ; Enterobacteriaceae infections ; Female ; Fluoroquinolones ; Follow-Up Studies ; Gastrointestinal Microbiome - drug effects ; Guidelines ; High-performance liquid chromatography ; Hospitals ; Humans ; Infant ; Infections ; International standardization ; Intestine ; Liquid chromatography ; Male ; Medicine ; Medicine and Health Sciences ; Outpatient care facilities ; Outpatients ; Parents ; Pathogens ; Patients ; Pediatric respiratory diseases ; Pharmacy ; Pharyngitis ; Physiology ; Prospective Studies ; Questionnaires ; Respiratory Tract Infections - diagnosis ; Respiratory Tract Infections - drug therapy ; Respiratory Tract Infections - pathology ; Severity of Illness Index ; Supervision ; Tonsillitis ; Tropical diseases ; Urine ; Vietnam ; Viruses
Is Part Of: PloS one, 2020-11, Vol.15 (11), p.e0241760
Description: 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. 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. 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 2nd and 3rd 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 3rd generation cephalosporin resistant intestinal Enterobacteriaceae during antibiotic use was observed, with co-selection of resistance to aminoglycosides and fluoroquinolones. 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. This study was registered at the International Standard Randomised Controlled Trials Number registry under number ISRCTN32862422: http://www.isrctn.com/ISRCTN32862422.
Publisher: United States: Public Library of Science
Language: English
Identifier: ISSN: 1932-6203
EISSN: 1932-6203
DOI: 10.1371/journal.pone.0241760
PMID: 33147269
Source: GFMER Free Medical Journals
MEDLINE
PubMed Central
Coronavirus Research Database
Public Library of Science (PLoS)
ProQuest Central
DOAJ Directory of Open Access Journals

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Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study

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