Intravenous antibiotics

Summary

The use of injectable antibiotics at home has gained favour in the last years, particularly for patients with chronic diseases. It has been seen that the ambulatory treatment of intercurrent illnesses has noticeably decreased the need for hospitalisation and therefore the risk of nosocomial infection, thus improving quality of life. 
This has been particularly useful in the paediatric age group, even without significant underlying pathology, due to the difficulty in giving long courses of oral therapy particularly in small children or those with vomiting or positing. 

We undertook a retrospective evaluation of prescriptions from a group of family paediatricians working in Padua within the Pedianet network to collect some information on the characteristics and frequency of home injectable antibiotic therapy. 


Objectives:
-Estimate the frequency of injectable antibiotic prescription by family paediatricians in a paediatric population in Padua 
Describe the diagnoses and motivation behind the choice of injectable antibiotic treatment 
-Estimate and compare the frequency of hospitalisation in children receiving oral and injectable antibiotic treatment 

Study Design:
Retrospective cohort study. 

Methods:
The study population includes all children between the ages of 0 ad 14 years who received at least one antibiotic prescription between the 1st January and the 31st December 1996 from the 16 family paediatricians working in the area covered by ULSS 16 (Padua) and connected to the paediatric network. 
The data from the from the prescription of antibiotics (in Groups A &B) made by the paediatrician was cross referenced by individual identification numbers to information on hospitalisations during the same study period. This data was provided by the Padua local health authority (ULSS 16). 
Diagnosis and reason for prescription were collected by a questionnaire filled out by the individual paediatricians. Using the individual patient identification numbers and the date of prescription the paediatricians retrospectively identified the child and diagnosis from their files. 
Questionnaires were used to collect further information on diagnoses of children who were prescribed injectable antibiotic therapy as well as the motivations for the choice (severity of llness, poor compliance, hospital prescription, etc.) to better define the motivation behind the prescription of an injectable antibiotic instead of an oral one 
A case was defined as any child who (according to the USSL 16 database) during follow-up, was hospitalised and who had a discharge diagnosis of an infectious pathology (acute upper or lower respiratory tract infection, otitis, gastroenteritis, sepsis, meningitis, myocarditis, lymphadenitis, urinary tract infection, cellulites). The study population is described by age and sex and was checked to see if it represented a fair sample (by 2*K Chi-squared test) with respect to the whole paediatric population followed by paediatricians of the local health authority (ULSS 16). 
The use of antibiotics was analysed according to the following: number of children prescribed that antibiotic, number and type of antibiotics and number of courses prescribed. The diagnoses of children prescribed injectable antibiotics and the motivation for this were also described. 
The incidence of hospitalisation was calculated using the cases as the numerator and the number of prescriptions or the duration/person of the treatment as denominators. 

Results:
35,175 children were followed by the Padua health authority in 1996 by 49 family paediatricians. 16 of these paediatricians tookpart in this study. 
For the purposes of the study we included 13,375 children under the age of 14 (38% of the total population). 11,730 of these (87.7%) received at least one prescription of any kind. To 7184 (61.2%) of the 13,375 received at least one course of oral antibiotics in 1996. 77 (0.66%) were prescribed an injectable antibiotic during the same time period. As 68 (88%) of the 77 also received oral antibiotics we have a total of 7193 (61.3%) receiving oral antibiotics. 

Conclusions
Injectable antibiotic treatment is very underutilised in children followed by the paediatricians taking part in this study. The frequency observed (<1%) is a lot less than that seen in literature of studies in adults. 

In our study injectable antibiotics were only prescribed in the presence of severe pathology which would otherwise have required hospitalisation. 

In children there is the possibility of poor compliance due to vomiting or refusal, an ulterior factor in advising injectable antibiotic therapy. We observed that the motivations behind the prescription of injectable antibiotics is comparable with those given in CUF, but is discordant with what observed in adults, in whom old age and associated pathology (diabetes, hypertension), rare in children, may explain the greater use of parenteral antibiotics. 

Analysis showed that treatment with injectable antibiotics carries a 12 times greater risk of hospitalisation. 
It is important however to nterpret this result with extreme caution. The main confounding factor is the severity of the underlying pathology which influences prescribing preferences. Injectable antibiotics are prescribed in severe infections, which may themselves be associated with 
a higher incidence of hospitalisation.

Partecipants and Collaborations

Coordinators

Luigi Cantarutti 
PLS, Padova 
Carlo Giaquinto 
Dipartimento di Pediatria, Universit√† di Padova 
Miriam CJM Sturkenboom 
CNR/ITBA, Milano 
Angelo Palozzo 
Servizio Farmaceutico, USSL 16, Padova 
Cecilia Giron 
Servizio Farmaceutico, USSL 16, Padova 
Gianfranco De Carli 
Farmacoepidemiologia, GlaxoWellcome

Partecipants

Marco Bernuzzi 
Carmelo Bucolo 
Roberto Bussi 
Luigi Cantarutti 
Maria Dal Zio 
Stefano Del Torso 
Franca Denes 
Stefano Drago 
Michele Felice 
Fabrizia Fumaneri 
Giuseppe Giancola 
Roberta Lucchelli 
Loredana Lovison 
Elena Menegus 
Stefania Perin 
Franco Pisetta

Collaborations

Miriam CJM sturkenboom, CNR/ITBA, Milano 
Angelo Palozzo, Servizio Farmaceutico, ULSS 16, Padova 
Cecilia Giron, Servizio Farmaceutico, ULSS 16, Padova 
Gianfranco De Carli, Farmacoepidemiologia, Glaxo Wellcome, Verona

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