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Journal of Korean Medical Science Jun 2024Antimicrobial resistance (AMR) is an important global public health concern in adults and children. Laryngotracheobronchitis (croup) is a common acute respiratory...
BACKGROUND
Antimicrobial resistance (AMR) is an important global public health concern in adults and children. Laryngotracheobronchitis (croup) is a common acute respiratory infection (ARI) among children, most often caused by a virus, and should not be treated with antibiotics. Reducing the usage of unnecessary antibiotics in ARI using an antimicrobial stewardship program (ASP) is an effective measure against AMR in children. This study investigates the antibiotic prescription pattern in pediatric patients with laryngotracheobronchitis in Korea. Our results will be useful to improve the ASP.
METHODS
The data were obtained from the government agency Health Insurance Review and Assessment Service. We analyzed outpatient prescriptions issued to children ≤ 5 years of age with a first-listed diagnosis code for laryngotracheobronchitis, i.e., International Classification of Disease, 10th Revision, code J050 (croup), J040 (laryngitis), or J041 (tracheitis), during 2017-2020. For each prescription, demographic information and information about medical facilities visited (type of hospital, specialty of physician, location of hospital) were extracted. The overall antibiotic prescription rate was subsequently estimated, and multivariable analysis was conducted to determine the associated factors of antibiotic prescription. Prescribed antibiotics were described and classified into extended-spectrum penicillins, cephalosporin, and macrolides.
RESULTS
Of 2,358,194 prescriptions reviewed, 829,172 (35.2%) contained antibiotics. In the multivariable analysis, management in a hospital was the strongest factor associated with antibiotic prescription (adjusted odds ratio [aOR], 22.33; 95% confidence interval [CI], 20.87-23.89; < 0.001), followed by management in a clinic (aOR, 12.66; 95% CI, 11.83-13.54; < 0.001) and management in a general hospital (aOR, 8.96; 95% CI, 8.37-9.59; < 0.001). Antibiotic prescription was also significantly associated with patients who were ≤ 2 years of age, managed by a pediatric specialist, and treated at a hospital located in a non-metropolitan region. Overall, extended-spectrum penicillins were the most frequently prescribed (18.6%) antibiotics, followed by cephalosporins (9.4%) and macrolides (8.5%).
CONCLUSION
The results of our study suggest that ASPs need to focus on physicians in hospitals, clinics, general hospitals, and pediatric specialties. Providing education programs to these groups to increase awareness of AMR and appropriate antibiotics use could be effective ASP policy and may help to reduce unnecessary prescriptions of antibiotics for laryngotracheobronchitis among pediatric patients and therefore potentially AMR in children in Korea.
Topics: Humans; Anti-Bacterial Agents; Republic of Korea; Child, Preschool; Infant; Male; Female; Tracheitis; Antimicrobial Stewardship; Laryngitis; Practice Patterns, Physicians'; Bronchitis; Infant, Newborn; Drug Prescriptions; Croup
PubMed: 38915281
DOI: 10.3346/jkms.2024.39.e189 -
Przeglad Epidemiologiczny Jun 2024Respiratory tract infections in children are an interdisciplinary problem that pediatricians, allergists, laryngologists and immunologists encounter on a daily basis. In...
INTRODUCTION
Respiratory tract infections in children are an interdisciplinary problem that pediatricians, allergists, laryngologists and immunologists encounter on a daily basis. In the youngest children, these diseases are caused by the structure of the respiratory tract, which is shorter and narrower than in an adult, as well as the immaturity of the immune system. Among all children under 5 years of age hospitalized due to respiratory diseases, 20% of cases are acute respiratory infections.
OBJECTIVE
The aim of the study is to discuss selected respiratory diseases in children aged 0-18 years hospitalized at the Pediatric Hospital in Bielsko-Biała.
MATERIAL AND METHODS
In June 2023, statistical data from the Pediatric Hospital was received regarding the number of hospitalized children aged 0-18 in 2015-2022. This article covers the following respiratory diseases: acute laryngitis, acute pharyngitis, pneumonia, bronchitis and bronchiolitis, bronchial asthma, adenoid hypertrophy and palatine tonsil hypertrophy coexisting with adenoid hypertrophy. Then, a table was prepared illustrating the trends of individual disease entities in the discussed time period.
RESULTS
A total of 5,573 hospitalizations were analyzed for the period from 2015-2022. The largest group of children (1,583) were hospitalized due to acute bronchitis and bronchiolitis (28.41%), due to hypertrophy of the adenoid (1,093) and palatine tonsils (1,039), which is 19.6% and 18.64% respectively. The smallest number of children and adolescents were hospitalized due to acute laryngotracheitis (474) and pharyngitis (361), which is 8.51% and 6.47%, respectively, and due to asthma (54), which is 0.97%. It has been observed that from 2017 to 2022 the number of hospitalized patients is constantly increasing due to acute pharyngitis and pneumonia, and from 2018 to 2022 due to acute laryngotracheitis.
CONCLUSIONS
In the analyzed Pediatric Hospital in Bielsko-Biała, the number of hospitalized children (from 0 to 18 years of age) due to pharyngitis, laryngotracheitis and pneumonia increased during the COVID-19 pandemic (2020-2022). The number of hospitalized patients due to pneumonia increased by as many as 70 from 2021 (197) to 2022 (267). In the case of hospitalizations for pharyngitis during the COVID-19 period, the number ranged from 46 in 2019 to 69 in 2022. Also in the case of acute laryngotracheitis in the period 2019-2022, the number of hospitalized young patients increases and ranges from 61 to 76. Respiratory tract infections are an important and common health problem for children. The vast majority of respiratory infections are caused by viruses.
Topics: Humans; Child; Child, Preschool; Infant; Adolescent; Poland; Infant, Newborn; Respiratory Tract Diseases; Hospitalization; Male; Female; Hospitals, Pediatric; Respiratory Tract Infections; Pneumonia; Asthma
PubMed: 38904312
DOI: 10.32394/pe.77.49 -
JTCVS Techniques Jun 2024
PubMed: 38899069
DOI: 10.1016/j.xjtc.2024.03.018 -
BMJ Paediatrics Open Jun 2024During the COVID-19 pandemic, the introduction of non-pharmaceutical interventions (NPIs) resulted in an unprecedented reduction in the transmission of the respiratory... (Observational Study)
Observational Study
During the COVID-19 pandemic, the introduction of non-pharmaceutical interventions (NPIs) resulted in an unprecedented reduction in the transmission of the respiratory syncytial virus (RSV), the predominant cause of bronchiolitis. As NPIs were eased, it was speculated that RSV transmission would return with an increase in the severity of bronchiolitis. In a large tertiary hospital, a dramatic reduction in the incidence of bronchiolitis was seen during the COVID-19 pandemic. The easing of NPIs correlated with an increase in RSV transmission particularly in the community; however, there was no evidence of an increase in the severity of bronchiolitis.
Topics: Humans; Respiratory Syncytial Virus Infections; COVID-19; Infant; SARS-CoV-2; Female; Male; Bronchiolitis; Incidence; Infant, Newborn; Respiratory Syncytial Virus, Human
PubMed: 38897622
DOI: 10.1136/bmjpo-2024-002603 -
International Journal of Molecular... May 2024Changes in gut microbiome composition have been implicated in the pathogenesis of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell...
Alteration of Gut Microbiota Composition and Diversity in Acute and/or Chronic Graft-versus-Host Disease Following Hematopoietic Stem Cell Transplantation: A Prospective Cohort Study.
Changes in gut microbiome composition have been implicated in the pathogenesis of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our objective was to explore the microbial abundance in patients with GvHD after allo-HSCT. We conducted a single-center, prospective study in patients who underwent allo-HSCT and developed grade II or higher acute GvHD and/or moderate or severe chronic GvHD, to explore the microbial abundance of taxa at the phylum, family, genus, and species level, and we utilized alpha and beta diversity indices to further describe our findings. We collected fecal specimens at -2 to +2 (T1), +11 to +17 (T2), +25 to +30 (T3), +90 (T4), and +180 (T5) days to assess changes in gut microbiota, with day 0 being the day of allo-HSCT. We included 20 allo-HSCT recipients in the study. Compared with timepoint T1, at timepoint T4 we found a significant decrease in the abundance of phylum (14.22% at T1 vs. 4.07% at T4, = 0.01) and family (13.3% at T1 vs. <0.05% at T4, < 0.05), as well as a significant increase in species (0.1% at T1 vs. 12.8% at T4, < 0.05) in patients who developed acute GvHD. Regarding patients who developed chronic GvHD after allo-HSCT, there was a significant reduction in the abundance of family (1.32% at T1 vs. 0.53% at T4, < 0.05) and genus (3.97% at T1 vs. 0.09% at T4, < 0.05) at T4 compared with T1. Alpha and beta diversity analyses did not reveal a difference in the abundance of bacteria at the genus level in GvHD patients at T4 compared with T1. Our study reinforces results from previous studies regarding changes in gut microbiota in patients with acute GvHD and provides new data regarding the gut microbiome changes in chronic GvHD. Future studies will need to incorporate clinical parameters in their analyses to establish their association with specific changes in gut microbiota in patients with GvHD after allo-HSCT.
Topics: Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Gastrointestinal Microbiome; Humans; Male; Female; Middle Aged; Adult; Prospective Studies; Chronic Disease; Feces; Transplantation, Homologous; Acute Disease; Young Adult; Aged; Bacteria; Bronchiolitis Obliterans Syndrome
PubMed: 38891979
DOI: 10.3390/ijms25115789 -
Current Medical Research and Opinion Jun 2024Acute bronchitis is the most common respiratory disease. Mixture of Ivy Leaf Extract and Coptidis rhizome syrup has shown good treatment efficacy against chronic...
Efficacy and safety of mixture of ivy leaf extract and coptidis rhizome in the treatment of acute bronchitis: multicenter, randomized, double-blinded, active-controlled, parallel, therapeutic confirmatory clinical trial.
BACKGROUND
Acute bronchitis is the most common respiratory disease. Mixture of Ivy Leaf Extract and Coptidis rhizome syrup has shown good treatment efficacy against chronic bronchitis and acute respiratory infections. This study aimed to evaluate the efficacy and safety of Mixture of Ivy Leaf Extract and Coptidis rhizome compared with those of extract, for the treatment of acute bronchitis.
METHODS
We performed a multicenter, randomized, double-blind, active-controlled, parallel phase III study in 220 patients with acute bronchitis. The participants were offered either Mixture of Ivy Leaf Extract and Coptidis rhizome syrup (AGS) and placebo of tablet or placebo syrup and active tablet of (AGU) for 7 days. The primary endpoint was the change in the Bronchitis Severity Score (BSS) from the baseline visit (visit 2) to day 7 (visit 3).
RESULTS
For the primary outcome, there was no significant difference in the change of total BSS between visits 2 and 3 (-4.10 ± 1.93 -4.24 ± 1.85, = 0.5125), and since the upper limit of the confidence interval (1.00) was smaller than the predetermined non-inferiority margin (1.17), it was confirmed that the AGS group was non-inferior to the AGU group. The changes in each symptom in the BSS between visits 2 and 3 also showed no significant differences. The overall improvement rate measured by the investigator (91.7 89.7%; = 0.3506) and the satisfaction rate of the participants at visit 3 also showed no significant differences (97.2 94.4%; = 0.4388). Regarding safety issues, adverse reactions were noted in both groups similarly, with no serious adverse events (4.55 3.64%, > 0.999).
CONCLUSION
Mixture of Ivy Leaf Extract and Coptidis rhizome syrup is as effective and safe as in controlling symptoms of acute bronchitis.
PubMed: 38889376
DOI: 10.1080/03007995.2024.2362273 -
Expert Review of Anti-infective Therapy Jun 2024In 2017 and 2021, the National Medical Products Administration (NMPA) announced to revise the drug label of fluoroquinolones. We aimed to evaluate the association of...
BACKGROUND
In 2017 and 2021, the National Medical Products Administration (NMPA) announced to revise the drug label of fluoroquinolones. We aimed to evaluate the association of fluoroquinolone prescribing with the NMPA announcements of label changes.
RESEARCH DESIGN AND METHODS
Monthly prevalence of fluoroquinolone prescriptions for uncomplicated urinary tract infections (uUTI), acute exacerbation of chronic bronchitis (AECB), and acute sinusitis (AS) between 2016 and 2022 was calculated, and interrupted time series analysis was applied to assess the impacts of NMPA label changes on fluoroquinolone use.
RESULTS
Prevalence of fluoroquinolone prescriptions decreased by 2.39% (95% CI, -4.72% to -0.07%) for uUTI but increased by 3.02% (95% CI, 1.71% to 4.34%) for AS immediately after the 2017 label change. Moreover, after the 2021 label change, fluoroquinolone use decreased shortly in all the three indications. However, a significant increasing trend was observed in fluoroquinolone use for AECB episodes, and fluoroquinolons were used for 61.4% of treated uUTI, 31.6% of treated AECB, and 5.42% of treated AS at the end of 2022, respectively.
CONCLUSIONS
The label changes issued by the NMPA had no substantial impacts on fluoroquinolone prescribing in the study region in China. Fluoroquinolone prescribing was still highly prevalent for uUTI and AECB and thus requiring further antimicrobial stewardship.
PubMed: 38881100
DOI: 10.1080/14787210.2024.2368823 -
Phytomedicine : International Journal... Aug 2024Asthma is a complex disease with mechanisms involving multiple factors, and there is still a lack of highly effective and low-side-effect drugs. Traditional Chinese...
BACKGROUND
Asthma is a complex disease with mechanisms involving multiple factors, and there is still a lack of highly effective and low-side-effect drugs. Traditional Chinese medicine Fagopyrum Dibotrys Rhizoma (FDR) has been applied for the treatment of acute and chronic bronchitis as well as bronchial asthma due to its favorable pharmacological activity. However, the exact mechanism of FDR remains unclear.
OBJECTIVE
A mouse model of asthma was created using OVA and HDM. To investigate the mechanism of FDR in asthma treatment, a combination of network pharmacology, lipidomics, and molecular biology approaches was employed.
METHODS
To evaluate the therapeutic effects of FDR on asthma, we established two distinct models of asthma in C57BL/6 J mice using OVA and HDM, respectively. We then employed LC-MS to analyze the major chemical constituents in FDR. Next, the network pharmacology approach was used to predict the potential targets and mechanisms of FDR in asthma treatment. Additionally, lipidomics analysis of mouse serum was conducted using LC-MS. Finally, the impact of FDR on the ERK -cPLA signaling pathway was investigated through Western Blotting assay.
RESULTS
FDR treatment has been shown to improve histomorphological changes, lung function and inflammation in models of OVA and HDM-induced asthma. Using UPLC/LTQ-Orbitrap-MS, we were able to identify 12 potential active components. Network pharmacology analysis revealed that FDR shares 75 targets with asthma. Further analysis using GO and KEGG pathways demonstrated the involvement of key pathways such as PI3K-Akt, TNF, and MAPK. Additionally, lipidomics analysis of the serum from OVA and HDM induced asthma mice showed disturbances in lipid metabolism, which were effectively ameliorated by FDR treatment. Mechanistically, FDR inhibits ERK1/2-cPLA, leading to a reduction in lysophospholipids and restoration of lipid balance, thereby aiding in the treatment of asthma.
CONCLUSION
FDR has been shown to improve lipid metabolism disorder in the serum of asthmatic mice, thereby potentially serving as a treatment for asthma. This can be achieved by regulating the activation levels of ERK1/2 and p38MAPK. Consequently, the production of lysophosphatide is reduced, thereby alleviating the disorder of lipid metabolism and achieving the desired therapeutic effect in asthma treatment.
Topics: Animals; Asthma; Mice, Inbred C57BL; Disease Models, Animal; Lipid Metabolism; Rhizome; Mice; Fagopyrum; Lung; MAP Kinase Signaling System; Female; Drugs, Chinese Herbal; Homeostasis; Lipidomics; Signal Transduction; Network Pharmacology; Ovalbumin; Phospholipases A2
PubMed: 38851102
DOI: 10.1016/j.phymed.2024.155782 -
Heliyon Jun 2024Less. is a perennial herb belonging to the Compositae family that has been used in traditional medicine as an antitussive and expectorant for treating chronic...
Rapid chemical characterization and pharmacological mechanism of Fining Granules in the treatment of chronic bronchitis based on UHPLC-Q-exactive orbitrap mass spectrometer and network pharmacology.
BACKGROUND
Less. is a perennial herb belonging to the Compositae family that has been used in traditional medicine as an antitussive and expectorant for treating chronic bronchitis and acute respiratory infections. Traditionally, Feining Granules are prepared from water extracts of the raw plant material. However, the chemical composition and pharmacological mechanisms of Feining Granules have not been thoroughly investigated.
METHODS
A systematic strategy for the rapid detection and identification of the constituents of Feining Granules was developed using ultrahigh-performance liquid chromatography-quadrupole-exactive orbitrap mass spectrometry (MS) with parallel reaction monitoring.
RESULTS
Overall, 162 compounds, including flavonoids, alkaloids, organic acids, and others, were identified unambiguously and tentatively by comparing the retention times and MS fragmentation with reference standards and literature data. Ninety-nine of these were reported for the first time to the best of our knowledge. Network pharmacology suggests that Feining Granules can be used to treat chronic bronchitis as they contain active components associated with the , , and target genes influenced by HIF-1, VEGF, and other signaling pathways.
CONCLUSION
These results provide information that can help understand the effective substances of Less. and improve quality control.
PubMed: 38845898
DOI: 10.1016/j.heliyon.2024.e31804 -
Clinics (Sao Paulo, Brazil) 2024To analyze whether infants admitted to hospital with Acute Viral Bronchiolitis (AVB), who received glucocorticoids and bronchodilators, and who had an atopic phenotype,...
OBJECTIVE
To analyze whether infants admitted to hospital with Acute Viral Bronchiolitis (AVB), who received glucocorticoids and bronchodilators, and who had an atopic phenotype, spent less time in hospital and/or less time on oxygen therapy when compared to those who did not have the phenotype.
METHOD
A cross-sectional, retrospective epidemiological study was developed with data from medical records of infants admitted to hospital due to AVB from 2012 to 2019 in a sentinel public hospital. It was verified that the frequency of prescription of glucocorticoids, bronchodilators and antibiotics. Length of stay and oxygen therapy duration were then compared in the group that used glucocorticoids and bronchodilators between those who had a personal or family history of atopy and those who did not. Subsequently, the length of hospital stay was compared among infants who received antibiotic therapy and those who did not.
RESULTS
Fifty-eight infants were included. Of these, 62.1 % received an antibiotic, 100 % a bronchodilator and 98.3 % a glucocorticoid. When comparing infants without a family history of atopy, those who received antibiotics had a longer hospital stay (p = 0.01).
CONCLUSION
The presence of an atopic phenotype did not interfere with the length of stay and/or oxygen therapy duration of those who received bronchodilators and glucocorticoids. Increased length of stay of infants without a family history of atopy, who used antibiotics without evidence of bacterial co-infection, and the high frequency of prescription of non-recommended drugs call attention to stricter protocol implementation and professional training in AVB diagnosis and care.
Topics: Humans; Bronchodilator Agents; Glucocorticoids; Male; Retrospective Studies; Cross-Sectional Studies; Bronchiolitis, Viral; Female; Infant; Length of Stay; Phenotype; Acute Disease; Anti-Bacterial Agents; Oxygen Inhalation Therapy; Treatment Outcome
PubMed: 38843677
DOI: 10.1016/j.clinsp.2024.100396