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*For medical professionals
only, the answer is of course no!
After some diagnosis and treatment, the doctor will prescribe symptomatic treatment drugs
to the baby.
However, pediatricians often find it difficult to determine the exact cause and etiology of lung infection in the first place, so children diagnosed with pneumonia are often treated with antibiotics
.
For the baby's mother, who is often sick, it seems that she has mastered a set of her own theories: mild upper respiratory tract infection, self-treated with a combination of Chinese proprietary medicine; In severe cases, cephalosporin antibiotics are directly added to treat bacterial infections; I am afraid of co-virus infection, so I add antiviral drugs
.
But is it really the right thing to do?
If the baby is sick, or even has pneumonia, must it be treated with antibiotics? The answer, of course, is no!
From 2008 to 2015, 6 million outpatient children aged 1-6 years were sampled nationwide in the United States
.
Community-acquired pneumonia (CAP) is known to be one of the most common infections in children and the disease with the highest total number of antibiotic days used in children's hospitals
.
In the United States, about 1.
5 million pediatric healthcare practitioners need to visit these children
with CAP who have been treated with antibiotics each year.
At the same time, most young children's CAP is actually caused by viral infections, and antibiotics are not therapeutic
.
of complete blood count, chest radiography, and antibiotic use in outpatient young children with community-acquired pneumonia in the United States, 2008-2015.
(a) complete blood count; (b) chest radiography; (c) blood cultures; (d) any antibiotics; (e) Narrow-spectrum antibiotics
.
The dotted line is the year of the Society of Pediatric Infectious Diseases/Infectious Diseases Society of America guidelines for pediatric CAP publication (2011)
Although there is evidence of limited benefit of complete blood analysis, chest imaging, blood cultures, and antibiotics in the treatment of children with community-acquired pneumonia
.
However, these tests and antibiotics are still high in outpatients, and most use macrolide or cephalosporin antibiotics is inconsistent
with the narrow-spectrum penicillin recommended as first-line in the guidelines.
It turns out that many young children with pneumonia and other common respiratory diseases will have overlapping clinical manifestations, resulting in uncertainty and difficulty in diagnosis
.
Although PIDS/IDSA guidelines recommend the diagnosis of CAP in the absence of radiology (i.
e.
, diagnosis based on clinical signs and symptoms), the clinical signs and symptoms commonly used to diagnose CAP lack reliability
。 In the absence of objective evidence to determine the causative agent causing CAP, clinicians prefer chest x-rays to confirm the diagnosis – so despite guideline recommendations, the likelihood of clinicians giving antibiotics to children remains high
.
References: 1.
Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia:
the PERCH multi-country case-control study style="font-size: 12px;color: rgb(136, 136, 136);" _mstmutation="1" _istranslated="1">2.
Viruses—not bacteria—cause most childhood pneumonia By Alex Fox Jun.
27, 2019 style="font-size: 12px;color: rgb(136, 136, 136);" _mstmutation="1" _istranslated="1"> 3.
2019 Journal of the Pediatric Infectious Diseases Society ：Diagnostic Testing and Antibiotic Use in Young Children With Community- Acquired Pneumonia in the United States, 2008–201
Source of this article: Medical communityThis article author: Li XiangThis article editor: Xiang Yu
You want to see the pediatric clinical knowledge doctor station App are available 👇
1.
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please contact the authorization - End -* "Medical Community" strives to publish content professionally and reliably, but does not make any commitment to the accuracy of the content; Relevant parties are requested to check
separately when adopting or using it as a basis for decision-making.
Call for Papers
only, the answer is of course no!
Pneumonia, the leading cause of death in children under 5 years of age globally, accounts for an estimated 12.
8% of neonatal deaths and causes nearly 1 million child deaths
each year.
Many pneumonia baby disease first go to the hospital for diagnosis and treatment of routine package examination: blood routine + CRP, chest x-ray, blood culture when fever, occasionally asked to do virus throat swabs, etc
.
After some diagnosis and treatment, the doctor will prescribe symptomatic treatment drugs
to the baby.
However, pediatricians often find it difficult to determine the exact cause and etiology of lung infection in the first place, so children diagnosed with pneumonia are often treated with antibiotics
.
For the baby's mother, who is often sick, it seems that she has mastered a set of her own theories: mild upper respiratory tract infection, self-treated with a combination of Chinese proprietary medicine; In severe cases, cephalosporin antibiotics are directly added to treat bacterial infections; I am afraid of co-virus infection, so I add antiviral drugs
.
But is it really the right thing to do?
If the baby is sick, or even has pneumonia, must it be treated with antibiotics? The answer, of course, is no!
One
Geng's Lancet says that most childhood pneumonia (about 60% of global cases) is actually caused
by viruses.
That is to say, the use of antibiotics at this time is actually ineffective
.
This conclusion comes from a study
by Knife Knife.
In order to understand the types of microorganisms caused by pneumonia in children and reduce the abuse of antibiotics, the researchers spent more than two years on 4232 children with pneumonia from Bangladesh, Gambia, Kenya, Mali, South Africa, Thailand and Zambia, cultured and multiplex PCR samples of nasopharyngeal and oropharyngeal secretions, as well as body fluid samples such as blood, sputum, urine, and gastric juice, and listed the pathogens that were most likely to cause pneumonia from 30 pathogens
Viruses accounted for 61.
4%, bacteria for 27.
3%, and mycobacterial tuberculosis for 5.
9%;Among viruses, respiratory syncytial virus (RSV) accounts for the largest
proportion.
Among cases with positive chest x-ray and no HIV infection, the ten most common specific pathogens are in various countries
It should be noted that among the causative pathogens of severe pneumonia, bacteria are still relatively common, and viruses are relatively rare
.
These pathogens also vary
by region.
The researchers also noted that the emergence of the virus, particularly RSV, as a major cause of pneumonia, highlights the urgent need
to develop new vaccines.
They also add that rapid diagnosis of the causative microorganism in children with pneumonia as a virus could also help reduce the overuse of antibiotics
globally.
RSV: respiratory syncytial virus
Two
Coincidentally, the Journal of the Pediatric Society of Infectious Diseases next door also "made up a knife": many children with pneumonia received unnecessary antibiotics and chest X-rays!
They recently published an analysis
of pre-diagnostic testing and antibiotic use in children with community-acquired pneumonia in the United States from 2008 to 2015.
From 2008 to 2015, 6 million outpatient children aged 1-6 years were sampled nationwide in the United States
.
Community-acquired pneumonia (CAP) is known to be one of the most common infections in children and the disease with the highest total number of antibiotic days used in children's hospitals
.
In the United States, about 1.
5 million pediatric healthcare practitioners need to visit these children
with CAP who have been treated with antibiotics each year.
At the same time, most young children's CAP is actually caused by viral infections, and antibiotics are not therapeutic
.
Therefore, the 2011 Society for Pediatric Infectious Diseases (PIDS)/Infectious Diseases Society of America (IDSA) guidelines for pediatric CAP recommend that chest imaging (CXR), complete blood analysis (CBC), and blood cultures are not routinely performed in children, nor are antibiotics routinely used in
preschool children.
If the child requires antibiotics, narrow-spectrum aminopenicillin is recommended as first-line therapy
.
Unnecessary testing and overuse of antibiotics may increase bacterial resistance, increase antibiotic-related adverse effects, and increase the cost of
hospitalization.
The researchers found that during the 8-year period from 2008 to 2015:
8.
6% of complete blood counts were performed;Blood cultures were performed in 11.
1%Imaging tests were performed in 43%;
Antibiotics accounted for 73.
9% of the administration, and most were second-line broad-spectrum antibiotics (i.
e.
, cephalosporins, macrolides).
There were no substantial changes
in these tests and antibiotic use before and after the guidelines were issued.
of complete blood count, chest radiography, and antibiotic use in outpatient young children with community-acquired pneumonia in the United States, 2008-2015.
(a) complete blood count; (b) chest radiography; (c) blood cultures; (d) any antibiotics; (e) Narrow-spectrum antibiotics
.
The dotted line is the year of the Society of Pediatric Infectious Diseases/Infectious Diseases Society of America guidelines for pediatric CAP publication (2011)
Although there is evidence of limited benefit of complete blood analysis, chest imaging, blood cultures, and antibiotics in the treatment of children with community-acquired pneumonia
.
However, these tests and antibiotics are still high in outpatients, and most use macrolide or cephalosporin antibiotics is inconsistent
with the narrow-spectrum penicillin recommended as first-line in the guidelines.
Three
It turns out that many young children with pneumonia and other common respiratory diseases will have overlapping clinical manifestations, resulting in uncertainty and difficulty in diagnosis
.
Although PIDS/IDSA guidelines recommend the diagnosis of CAP in the absence of radiology (i.
e.
, diagnosis based on clinical signs and symptoms), the clinical signs and symptoms commonly used to diagnose CAP lack reliability
。 In the absence of objective evidence to determine the causative agent causing CAP, clinicians prefer chest x-rays to confirm the diagnosis – so despite guideline recommendations, the likelihood of clinicians giving antibiotics to children remains high
.
In summary, what we need to know is:
In preschool children, especially immunocompetent children, 70% to 80% of CAP cases are not caused by bacteria, which indicates that antibiotics should not be given blindly to such children
.Antibiotic use is not therapeutic, and we should avoid overuse
of antimicrobials.
(Note: Children with lower respiratory tract infections are not included here
.
) ）
Reasonable examination and rational use of antibiotics not only avoid the overuse or even abuse of antibiotics, but also reduce the spread of antimicrobial resistance, reduce antibiotic-related adverse reactions, and also reduce the cost of nursing for children!
References: 1.
Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia:
the PERCH multi-country case-control study style="font-size: 12px;color: rgb(136, 136, 136);" _mstmutation="1" _istranslated="1">2.
Viruses—not bacteria—cause most childhood pneumonia By Alex Fox Jun.
27, 2019 style="font-size: 12px;color: rgb(136, 136, 136);" _mstmutation="1" _istranslated="1"> 3.
2019 Journal of the Pediatric Infectious Diseases Society ：Diagnostic Testing and Antibiotic Use in Young Children With Community- Acquired Pneumonia in the United States, 2008–201
Source of this article: Medical communityThis article author: Li XiangThis article editor: Xiang Yu
You want to see the pediatric clinical knowledge doctor station App are available 👇
1.
Scan the QR code
below 2.
Click "Download Now" Download the Doctor Station App, subscribe anytime, anywhere~ Copyright statementThis article is original,
please contact the authorization - End -* "Medical Community" strives to publish content professionally and reliably, but does not make any commitment to the accuracy of the content; Relevant parties are requested to check
separately when adopting or using it as a basis for decision-making.
Call for Papers
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