Department of Pediatrics, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.
Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Eur J Clin Microbiol Infect Dis. 2019 Apr;38(4):675-681. doi: 10.1007/s10096-019-03473-7. Epub 2019 Jan 24.
For reasons of antibiotic resistance and side effects, macrolides should be prescribed with care in the pediatric population. We evaluated the adherence to Dutch guidelines of macrolide prescription in children and estimated the risk of Mycoplasma pneumoniae-associated pneumonia based on Fischer's decision tree. In this retrospective study, we included children aged 0-18 years who were treated with azithromycin or clarithromycin for pulmonary disease in four settings from general practice to hospital ward for (1) the prescriptions not in accordance with the guideline of the Dutch Association of Pediatrics and (2) the risk of M. pneumoniae in patients with community-acquired pneumonia (CAP) according to Fischer's decision tree. The latter suggests that children older than three years with a fever lasting more than two days are at high risk for M. pneumoniae and that it is therefore justified to treat them with macrolides. In total, 189 macrolide prescriptions from 2015 until 2017 were analyzed: 139 children used macrolides for a pulmonary indication (75%); 18% (n = 25) of the prescriptions were not in accordance with Dutch guidelines. Only 9.1% of patients with CAP were classified as having a high risk of M. pneumoniae according to Fischer's decision tree. A significant proportion of macrolide prescriptions for Dutch children with a pulmonary disease appears not to be in accordance with the guidelines. Most patients with CAP treated with a macrolide actually had a low risk of having M. pneumoniae according to Fischer's decision tree. Both observations suggest overuse of macrolides in children.
由于抗生素耐药性和副作用的原因，大环内酯类药物在儿科人群中应谨慎使用。我们评估了荷兰儿科协会指南中关于大环内酯类药物处方的遵循情况，并根据 Fischer 决策树估计了肺炎支原体相关肺炎的风险。在这项回顾性研究中，我们纳入了在普通儿科诊所到住院病房的四个医疗场所因肺部疾病而接受阿奇霉素或克拉霉素治疗的 0-18 岁儿童，其中包括：(1) 不符合荷兰儿科学会指南的处方；(2) 根据 Fischer 决策树，社区获得性肺炎 (CAP) 患者中肺炎支原体的风险。该决策树提示，发热超过两天的三岁以上儿童存在高风险的肺炎支原体感染，因此使用大环内酯类药物进行治疗是合理的。总共分析了 2015 年至 2017 年的 189 份大环内酯类药物处方：139 名儿童因肺部疾病使用了大环内酯类药物（75%）；18%（n=25）的处方不符合荷兰指南。根据 Fischer 决策树，只有 9.1%的 CAP 患者被归类为肺炎支原体高风险。荷兰患有肺部疾病的儿童中，大环内酯类药物的处方有相当一部分似乎不符合指南。根据 Fischer 决策树，实际上大多数使用大环内酯类药物治疗的 CAP 患者发生肺炎支原体感染的风险较低。这两种观察结果均表明，儿童中存在大环内酯类药物的过度使用。
