Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium.
Am J Trop Med Hyg. 2023 Oct 30;109(6):1245-1259. doi: 10.4269/ajtmh.23-0322. Print 2023 Dec 6.
Severe bacterial infections in children need prompt, appropriate antibiotic treatment. We report challenges observed within a prospective, cohort study on antibiotic efficacy in non-typhi Salmonella bloodstream infection (NCT04850677) in Kisantu district hospital (Democratic Republic of Congo). Children (aged > 28 days to < 5 years) admitted with suspected bloodstream infection (August 1, 2021 through July 31, 2022) were enrolled and followed until day 3 or discharge for non-typhi Salmonella patients. Antibiotics were administered to 98.4% (1,838/1,867) of children, accounting for 2,296 antibiotic regimens (95.7% intravenous, 4.3% oral). Only 78.3% and 61.8% of children were, respectively, prescribed and administered antibiotics on the admission day. At least one dose was not administered in 3.6% of children, mostly because of mismatch of the four times daily cefotaxime schedule with the twice-daily administration rounds. Inappropriate intravenous administration practices included multidose use, air-venting, and direct injection instead of perfusion. There was inaccurate aliquoting in 18.0% (32/178) of intravenous ciprofloxacin regimens, and thus administered doses were > 16% below the intended dose. Dosing accuracy of oral suspensions was impaired by lack of instructions for reconstitution, volume indicators, and/or dosing devices. Adult-dose tablets were split without/beyond scoring lines in 84.4% (27/32) of tablets. Poor availability and affordability of age-appropriate oral formulations contributed to low proportions of intravenous-to-oral switch (33.3% (79/237) of non-typhi Salmonella patients). Other quality issues included poor packaging, nonhomogeneous suspensions, and unsafe water for reconstitution. In conclusion, poor antibiotic products (no age-appropriate formulations, poor quality and access), processes (delayed prescription/administration, missed doses), and practices (inaccurate doses, [bio]safety risks) must be urgently addressed to improve pediatric antibiotic treatment.
儿童严重细菌感染需要及时、恰当的抗生素治疗。我们报告了在金沙萨区医院（刚果民主共和国）进行的非伤寒沙门氏菌血流感染抗生素疗效前瞻性队列研究（NCT04850677）中观察到的挑战。年龄>28 天至<5 岁的疑似血流感染患儿（2021 年 8 月 1 日至 2022 年 7 月 31 日期间入院）被纳入研究并随访至第 3 天或出院。98.4%（1838/1867）的患儿接受了抗生素治疗，共使用了 2296 种抗生素方案（95.7%静脉，4.3%口服）。分别只有 78.3%和 61.8%的患儿在入院当天按医嘱接受了抗生素治疗。3.6%的患儿未按规定接受至少一剂抗生素，主要是因为头孢噻肟每日 4 次的方案与每日 2 次的给药轮次不匹配。不恰当的静脉给药包括多剂量使用、空气通气和直接注射而不是灌注。18.0%（32/178）的静脉用环丙沙星方案中存在不准确的等分剂量，因此给予的剂量比预期剂量低 16%以上。口服混悬剂的剂量准确性因缺乏再配置说明、体积指标和/或给药装置而受损。84.4%（27/32）的片剂未按/超出划线分割成人剂量的片剂。缺乏适合年龄的口服制剂的可用性和可负担性导致非伤寒沙门氏菌患者中静脉到口服转换的比例较低（33.3%（79/237））。其他质量问题包括包装不良、混悬液不均匀以及再配置用水不安全。总之，必须紧急解决抗生素产品（无适合年龄的制剂、质量和供应差）、流程（延迟处方/给药、漏用剂量）和实践（剂量不准确、[生物]安全风险）问题，以改善儿科抗生素治疗。
