amoxicillin-potassium-clavulanate-combination and Influenza--Human

To characterise the quality of life, healthcare use and costs associated with early antibiotic treatment of influenza-like illness (ILI) in 'at-risk' children.. Economic analysis of a two-arm double-blind parallel group pragmatic randomised controlled trial.. Children were recruited from community-based healthcare settings, including general practices, walk-in centres and hospital ambulatory care.. Children with risk factors for influenza-related complications, including respiratory, cardiac and neurological conditions, who presented within the first 5 days of an ILI.. Co-amoxiclav 400/57 suspension or placebo.. This economic analysis focused on quality of life measured by the EQ-5D-Y, symptoms assessed by the Canadian Acute Respiratory Infection and Flu Scale (CARIFS), healthcare use and costs including medication, hospital visits and admissions, general practitioner and nurse contacts. Outcomes were assessed for up to 28 days post randomisation.. Information on resource use, EQ-5D-Y (day 28) and CARIFS (day 7) was available for 265 (98%), 72 (27%) and 123 (45%) out of 271 participants, respectively. Average costs in the co-amoxiclav group were £25 lower (95% CI -£113 to £65), but this difference was not statistically significant (p=0.566). The difference in EQ-5D-Y scores between groups was also not statistically significant (-0.014 (95% CI -0.124 to 0.096), p=0.798). However, day 7 CARIFS scores were 3.5 points lower in the co-amoxiclav arm (95% CI -6.9 to -0.1, p=0.044).. Our findings did not show evidence that early co-amoxiclav treatment improves quality of life or reduces healthcare use and costs in 'at-risk' children with ILI, but may reduce symptom severity though confirmation from further research would be important. Reliable data collection from children's parents/carers was challenging, and resulted in high levels of missing data, which is common in pragmatic trials involving children with acute respiratory tract infections.. ISRCTN70714783; EudraCT 2013-002822-21.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Canada; Child; Cost-Benefit Analysis; Delivery of Health Care; Humans; Influenza, Human; Quality of Life; Respiratory Tract Infections; Virus Diseases

Influenza and influenza-like illness (ILI) create considerable burden on healthcare resources each winter. Children with pre-existing conditions such as asthma, diabetes mellitus and cerebral palsy are among those at greatest risk of clinical deterioration from influenza/ILI. The Antibiotics for at Risk CHildren with InfluEnza (ARCHIE) trial aims to determine whether early oral treatment with the antibiotic co-amoxiclav reduces the likelihood of reconsultation due to clinical deterioration in these 'at risk' children.. The ARCHIE trial has been reviewed and approved by the North West-Liverpool East Research Ethics Committee, Health Research Authority and Medicines and Healthcare Products Regulatory Agency. Our findings will be published in peer-reviewed journals and disseminated via our study website (www.archiestudy.com) and links with relevant charities.. ISRCTN 70714783; Pre-results. EudraCT 2013-002822-21; Pre-results.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Child, Preschool; Double-Blind Method; Female; Humans; Infant; Influenza, Human; Male; Randomized Controlled Trials as Topic; Registries; Regression Analysis; Time Factors; Treatment Outcome; United Kingdom

Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal white blood cell counts have poor sensitivity for invasive bacterial infections; procalcitonin and C-reactive protein levels, when available, are more informative. Chest radiography is rarely recommended for children older than 28 days in the absence of localizing signs. Lumbar puncture is not recommended for children older than three months without localizing signs; it may also be considered for those from one to three months of age with abnormal laboratory test results. Protocols such as Step-by-Step, Laboratory Score, or the Rochester algorithms may be helpful in identifying low-risk patients. Rapid influenza testing and tests for coronavirus disease 2019 (COVID-19) may be of value when those diseases are circulating. When empiric treatment is appropriate, suggested antibiotics include ceftriaxone or cefotaxime for infants one to three months of age and ampicillin with gentamicin or with cefotaxime for neonates. For children three months to three years of age, azithromycin or amoxicillin is recommended if pneumonia is suspected; for urinary infections, suggested antibiotics are cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole. Choice of antibiotics should reflect local patterns of microbial resistance.

Topics: Algorithms; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Betacoronavirus; Blood Culture; C-Reactive Protein; Child, Preschool; Clinical Decision-Making; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Culture Techniques; Fever; Humans; Infant; Infant, Newborn; Influenza, Human; Leukocyte Count; Pandemics; Pneumonia, Bacterial; Pneumonia, Viral; Procalcitonin; Radiography, Thoracic; SARS-CoV-2; Spinal Puncture; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

The aim was to describe the factors associated with antibiotic use in upper respiratory tract infections (URTI) in the post-pandemic influenza period.. All consecutive patients who attended the emergency and outpatient departments of a private 265-bed hospital in Istanbul, Turkey with symptoms of an influenza-like illness (ILI) between January and June 2011 were included.. Out of 1270 patients, 100 were tested for Streptococcus A infection and 16 (16%) were found to be positive; 36 patients were tested for respiratory syncytial virus and five were found to be positive. A rapid influenza test (chromatographic) was performed for 325 patients and 45% were found to be positive for influenza A or B. In total, 500 patients (40%) were prescribed antibiotics; these were fluoroquinolones (12%), macrolides (10%), amoxicillin-clavulanate (10%), cefuroxime (7%), and third-generation cephalosporins (3%). On multivariate analysis, antibiotic prescription was found to be decreased by the diagnosis of influenza, whereas antibiotic prescription increased with age >65years, C-reactive protein (CRP) >20mg/L, polymorphonuclear leukocytes >80%, the detection of rales on auscultation, the presence of cough, comorbidities, and having infiltrations on a X-ray.. The diagnosis of influenza is important for the implementation of antimicrobial stewardship programs. Each institution should implement an algorithm for the diagnosis and management of upper respiratory tract infections. Biomarkers such as CRP and procalcitonin should be used more effectively.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antimicrobial Stewardship; C-Reactive Protein; Cephalosporins; Child; Child, Preschool; Female; Fluoroquinolones; Humans; Infant; Influenza, Human; Macrolides; Male; Middle Aged; Pandemics; Respiratory Tract Infections; Retrospective Studies; Turkey; Virus Diseases; Young Adult

To determine the susceptibility of lower respiratory tract (LRT) isolates of Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae to antimicrobial agents recommended by UK guidelines for treatment of pneumonia associated with influenza-like illness.. Analysis of antimicrobial susceptibility data from sentinel microbiology laboratories in England, Wales and Northern Ireland was carried out. Subjects comprised patients who had an LRT specimen taken in a general practitioner surgery or hospital outpatient setting between January 2007 and March 2010. The main outcome measurements were antimicrobial susceptibility trends of LRT isolates over time, between patient age groups and in different geographical regions.. Susceptibility to tetracyclines or co-amoxiclav was high. Of the 70,288 and 45,288 isolates with susceptibility results for tetracyclines or co-amoxiclav, 96% and 92%, respectively, were susceptible. Overall susceptibility to ciprofloxacin, ampicillin/amoxicillin and macrolides was lower than for tetracyclines or co-amoxiclav and varied markedly by organism. There were few clinically relevant variations in susceptibility to doxycycline or co-amoxiclav over time, geographically or between age groups.. The data support the use of doxycycline or co-amoxiclav as appropriate empiric treatment for LRT infection caused by the pathogens investigated, for patients in primary care.

Topics: Adult; Age Factors; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Databases, Factual; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Influenza, Human; Male; Microbial Sensitivity Tests; Middle Aged; Opportunistic Infections; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Primary Health Care; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae; Tetracyclines