Nguyen Phuong Tk, Nguyen Tam Tm, Huynh Lan Tb, Graham Stephen M, Marais Ben J
Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam.
Sydney Vietnam Initiative, The University of Sydney, Sydney, Australia.
Pneumonia (Nathan). 2023 Jul 25;15(1):11. doi: 10.1186/s41479-023-00113-9.
To assess the safety and utility of a pragmatic clinical algorithm to guide rational antibiotic use in children presenting with respiratory infection.
The effect of an algorithm to guide the management of young (< 5 years) children presenting with respiratory symptoms to the Da Nang Hospital for Women and Children, Vietnam, was evaluated in a before-after intervention analysis. The main outcome was reduction in antibiotic use, with monitoring of potential harm resulting from reduced antibiotic use. The intervention comprised a single training session of physicians in the use of an algorithm informed by local evidence; developed during a previous prospective observational study. The evaluation was performed one month after the training.
Of the 1290 children evaluated before the intervention, 102 (7.9%) were admitted to hospital and 556/1188 (46.8%) were sent home with antibiotics. Due to COVID-19, only 166 children were evaluated after the intervention of whom 14 (8.4%) were admitted to hospital and 54/152 (35.5%) were sent home with antibiotics. Antibiotic use was reduced (from 46.8% to 35.5%; p = 0.009) after clinician training, but adequate comparison was compromised. The reduction was most pronounced in children with wheeze or runny nose and no fever, or a normal chest radiograph, where antibiotic use declined from 46.7% to 28.8% (p < 0.0001). The frequency of repeat presentation to hospital was similar between the two study periods (141/1188; 11.9% before and 10/152; 6.6% after; p = 0.10). No child represented with serious disease after being sent home without antibiotics.
We observed a reduction in antibiotic use in young children with a respiratory infection after physician training in the use of a simple evidence-based management algorithm. However, the study was severely impacted by COVID-19 restrictions, requiring further evaluation to confirm the observed effect.
评估一种实用临床算法在指导患有呼吸道感染的儿童合理使用抗生素方面的安全性和实用性。
在一项前后干预分析中，评估了一种算法对越南岘港妇幼医院出现呼吸道症状的幼儿（<5岁）管理的效果。主要结果是抗生素使用的减少，并监测因抗生素使用减少而产生的潜在危害。干预措施包括为医生提供一次关于使用基于当地证据制定的算法的培训课程；该算法是在之前的一项前瞻性观察研究中开发的。评估在培训后一个月进行。
在干预前评估的1290名儿童中，102名（7.9%）入院，556/1188名（46.8%）使用抗生素后被送回家。由于新冠疫情，干预后仅评估了166名儿童，其中14名（8.4%）入院，54/152名（35.5%）使用抗生素后被送回家。临床医生培训后抗生素使用减少（从46.8%降至35.5%；p = 0.009），但充分的比较受到影响。在有喘息或流鼻涕且无发热或胸部X光正常的儿童中减少最为明显，抗生素使用从46.7%降至28.8%（p < 0.0001）。两个研究期间再次住院的频率相似（141/1188；之前为11.9%，之后为10/152；6.6%；p = 0.10）。没有儿童在未使用抗生素被送回家后出现严重疾病。
我们观察到，在医生接受使用简单的循证管理算法培训后，患有呼吸道感染的幼儿抗生素使用减少。然而，该研究受到新冠疫情限制的严重影响，需要进一步评估以确认观察到的效果。
