Quality of care for children with severe disease in the Democratic Republic of the Congo

By Clarke-Deelder E, Shapira G, Samaha H, Fritsche GB, Fink G

BMC Public Health, December 2,  2019

 

Despite the almost universal adoption of Integrated Management of Childhood Illness (IMCI) guidelines for the diagnosis and treatment of sick children under the age of five in low- and middle-income countries, child mortality remains high in many settings. One possible explanation of the continued high mortality burden is lack of compliance with diagnostic and treatment protocols. We test this hypothesis in a sample of children with severe illness in the Democratic Republic of the Congo (DRC).

 

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Effect of co-trimoxazole prophylaxis on morbidity and mortality of HIV-exposed, HIV-uninfected infants in South Africa: a randomised controlled, non-inferiority trial

By Brodie Daniels, Anna Coutsoudis, Eshia Moodley-Govender, Helen Mulol, Elizabeth Spooner, Photini Kiepiela, et al.

The Lancet Global Health, December, 2019

WHO guidelines recommend co-trimoxazole prophylaxis for HIV-exposed, HIV-uninfected infants. These guidelines date back to an era in which HIV testing of infants was impossible and mothers had poor access to antiretroviral treatment. To determine whether this guideline requires revision in the current era of effective prevention of mother-to-child transmission and early infant diagnosis programmes, we aimed to investigate whether receiving no co-trimoxazole prophylaxis is inferior to receiving co-trimoxazole prophylaxis in the resulting incidence of grade 3 or 4 common childhood illnesses or mortality in breastfed HIV-exposed, HIV-uninfected infants.

We screened 1570 mother–child pairs for study enrolment, from whom (78%) eligible infants were enrolled into the study between Oct 16, 2013, and May 23, 2018. Of the infants enrolled, 611 (50%) were randomly assigned to the co-trimoxazole group and 609 (50%) were randomly assigned to the no co-trimoxazole group. One (<1%) infant in the no co-trimoxazole group was excluded from the analysis of the final outcomes for having received traditional medicine (which only became apparent after randomisation); therefore, 611 (50%) infants in the co-trimoxazole group and 608 (50%) infants in the no co-trimoxazole group were included in the final intention-to-treat analysis. 136 (22%) infants in the co-trimoxazole group and 139 (23%) infants in the no co-trimoxazole group did not complete the 12-month study visit, predominantly because of loss to follow-up (93 [15%] infants in the co-trimoxazole group; 90 [15%] infants in the no co-trimoxazole group). The cumulative probability of the composite primary outcome was 0·114 (95% CI 0·076 to 0·147; 49 events) in the co-trimoxazole group versus 0·0795 (0·044 to 0·115; 39 events) in the no co-trimoxazole group. The risk difference (no co-trimoxazole group minus co-trimoxazole group) was −0·0319 (–0·075 to 0·011), meaning that the risk was around 3 percentage points lower in the no co-trimoxazole group on the additive scale.

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Survival benefit associated with clarithromycin in severe community-acquired pneumonia: A matched comparator study

By Evdoxia Kyriazopoulou, Dimitrios Sinapidis, Stamatios Halvatzis, Dimitrios Velissaris, Nikolaos Alexiou, Vasilios Kosmase, Maria Evangelia Adami,  Miltiades Kyprianou,  Aikaterini Kyprianou,  Aggelos Stefos,  Malvina Lada, et al.

 

International Journal of Antimicrobial Agents, November 5, 2019

 

Although analysis of retrospective studies has documented survival benefit from the addition of a macrolide to the treatment regimen for community-acquired pneumonia (CAP), no data are available to determine if there is differential efficacy between members of the macrolide family. In order to investigate this, an analysis was undertaken of data from 1174 patients with CAP who met the new Sepsis-3 definitions and were enrolled prospectively in the data registry of the Hellenic Sepsis Study Group. Four well-matched treatment groups were identified with 130 patients per group: clarithromycin and β-lactam; azithromycin and β-lactam; respiratory fluoroquinolone and β-lactam monotherapy. The primary endpoint was comparison of the effects of clarithromycin with β-lactam monotherapy on 28-day mortality. The secondary endpoint was resolution of CAP. Mortality rates for the clarithromycin, azithromycin, respiratory fluoroquinolone and β-lactam groups were 20.8%, 33.8% (P=0.026 vs clarithromycin), 32.3% (P=0.049 vs clarithromycin) and 36.2% (P=0.009 vs clarithromycin), respectively. After stepwise Cox regression analysis among all groups, clarithromycin was the only treatment modality associated with a favourable outcome (hazard ratio 0.61; P=0.021). CAP resolved in 73.1%, 65.9% (P=0.226 vs clarithromycin), 58.5% (P=0.009 vs clarithromycin) and 61.5% (P=0.046 vs clarithromycin) of patients, respectively. It is concluded that the addition of clarithromycin to the treatment regimen of patients with severe CAP leads to better survival rates.

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The Impact of the Duration of Antibiotic Therapy in Patients With Community-Onset Pneumonia on Readmission Rates: A Retrospective Cohort Study

By Daniel M. Parshall, Julia E. Sessa, Kelly M. Conn, Lisa M. Avery

Journal of Pharmacy Practice, October 23, 2019

 

The primary objective is to evaluate the relationship between antibiotic duration and all-cause 30-day readmission rates. Secondary outcomes include pneumonia-specific 30-day readmission rate and identification of risk factors for readmission.

Patients aged ≥18 years with a primary diagnosis of pneumonia from January 1, 2016, to December 31, 2016, were included in this single-center, retrospective cohort study. Patients were categorized by antibiotic therapy duration of ≤7 days (n = 139) or >7 days (n = 286), and outcomes were analyzed in both bivariate and multivariate models. A multivariate logistic regression was used to assess the relationship between all-cause 30-day readmission and antibiotic days.

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WHO Practical toolkit: Antimicrobial Stewardship Programmes in Health-Care Facilities in Low- and Middle-Income Countries.

Following two years of hard work, involving international AMS experts, wide consultations and feasibility studies in LMICs, WHO is  happy to share the newly published “WHO Practical Toolkit: Antimicrobial Stewardship Programmes in Health-Care Facilities in Low- and Middle-Income Countries” view full toolkit here.

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