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Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study

Minh, Ngo Ngoc Quang, Toi, Pham Van, Qui, Le Minh, Tinh, Le Binh Bao, Ngoc, Nguyen Thi, Kim, Le Thi Ngoc, Uyen, Nguyen Hanh, Hang, Vu Thi Ty, Chinh B’Krong, Nguyen Thi Thuy, Tham, Nguyen Thi, Khoa, Thai Dang, Khuong, Huynh Duy, Vi, Pham Quynh, Phuc, Nguyen Ngoc Hong, Vien, Le Thi Minh, Pouplin, Thomas, Khanh, Doan Van, Phuong, Pham Nguyen, Lam, Phung Khanh, Wertheim, Heiman F. L., Campbell, James I., Baker, Stephen, Parry, Christopher, Bryant, Juliet E., Schultsz, Constance, Hung, Nguyen Thanh, de Jong, Menno D. and van Doorn, H. Rogier (2020) 'Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study'. PLoS ONE, Vol 15, Issue 11, e0241760.

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Background and objectives
Treatment guidelines do not recommend antibiotic use for acute respiratory infections (ARI), except for streptococcal pharyngitis/tonsillitis and pneumonia. However, antibiotics are prescribed frequently for children with ARI, often in absence of evidence for bacterial infection. The objectives of this study were 1) to assess the appropriateness of antibiotic prescriptions for mild ARI in paediatric outpatients in relation to available guidelines and detected pathogens, 2) to assess antibiotic use on presentation using questionnaires and detection in urine 3) to assess the carriage rates and proportions of resistant intestinal Enterobacteriaceae before, during and after consultation.

Materials and methods
Patients were prospectively enrolled in Children’s Hospital 1, Ho Chi Minh City, Vietnam and diagnoses, prescribed therapy and outcome were recorded on first visit and on follow-up after 7 days. Respiratory bacterial and viral pathogens were detected using molecular assays. Antibiotic use before presentation was assessed using questionnaires and urine HPLC. The impact of antibiotic usage on intestinal Enterobacteriaceae was assessed with semi-quantitative culture on agar with and without antibiotics on presentation and after 7 and 28 days.

A total of 563 patients were enrolled between February 2009 and February 2010. Antibiotics were prescribed for all except 2 of 563 patients. The majority were 2nd and 3rd generation oral cephalosporins and amoxicillin with or without clavulanic acid. Respiratory viruses were detected in respiratory specimens of 72.5% of patients. Antibiotic use was considered inappropriate in 90.1% and 67.5%, based on guidelines and detected pathogens, respectively. On presentation parents reported antibiotic use for 22% of patients, 41% of parents did not know and 37% denied antibiotic use. Among these three groups, six commonly used antibiotics were detected with HPLC in patients’ urine in 49%, 40% and 14%, respectively. Temporary selection of 3rd generation cephalosporin resistant intestinal Enterobacteriaceae during antibiotic use was observed, with co-selection of resistance to aminoglycosides and fluoroquinolones.

We report overuse and overprescription of antibiotics for uncomplicated ARI with selection of resistant intestinal Enterobacteriaceae, posing a risk for community transmission and persistence in a setting of a highly granular healthcare system and unrestricted access to antibiotics through private pharmacies.

Item Type: Article
Subjects: QV Pharmacology > Anti-Bacterial Agents. Tissue Extracts > QV 350 Anti-bacterial agents (General or not elsewhere classified)
QW Microbiology and Immunology > Bacteria > QW 138 Enterobacteriaceae
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 505 Viral respiratory tract infections
WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 200 General works
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 310 Digestive system
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 30 Nov 2020 11:32
Last Modified: 30 Nov 2020 11:32


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