Mar 31, 2005

Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study

BMJ : British Medical Journal
James A BerkleyMike English

Abstract

To determine how well antibiotic treatment is targeted by simple clinical syndromes and to what extent drug resistance threatens affordable antibiotics. Observational study involving a priori definition of a hierarchy of syndromic indications for antibiotic therapy derived from World Health Organization integrated management of childhood illness and inpatient guidelines and application of these rules to a prospectively collected dataset. Kilifi District Hospital, Kenya. 11,847 acute paediatric admissions. Presence of invasive bacterial infection (bacteraemia or meningitis) or Plasmodium falciparum parasitaemia; antimicrobial sensitivities of isolated bacteria. 6254 (53%) admissions met criteria for syndromes requiring antibiotics (sick young infants; meningitis/encephalopathy; severe malnutrition; very severe, severe, or mild pneumonia; skin or soft tissue infection): 672 (11%) had an invasive bacterial infection (80% of all invasive bacterial infections identified), and 753 (12%) died (93% of all inpatient deaths). Among P falciparum infected children with a syndromic indication for parenteral antibiotics, an invasive bacterial infection was detected in 4.0-8.8%. For the syndrome of meningitis/encephalopathy, 96/123 (76%) isol...Continue Reading

  • References18
  • Citations88

References

  • References18
  • Citations88

Citations

Mentioned in this Paper

Trichohepatoenteric Syndrome
Spinal Puncture
Antibiotic throat preparations
Antifungal Antibiotics, Topical
Malaria, Falciparum
Pediatric Discipline
Parenteral Route of Drug Administration
Antibiotics, Gynecological
Malaria
Malaria Vaccines

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