Young Zambian infants with symptomatic RSV and pertussis infections are frequently prescribed inappropriate antibiotics: a retrospective analysis.

Autor:	Gunning CE; Odum School of Ecology, University of Georgia, Athens, GA, United States of America., Rohani P; Odum School of Ecology, University of Georgia, Athens, GA, United States of America.; Center for the Ecology of Infectious Diseases; Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America.; Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America., Mwananyanda L; School of Public Health, Department of Global Health, Boston University, Boston, MA, United States of America.; Right to Care Zambia, Lusaka, Zambia., Kwenda G; School of Health Sciences, Department of Biomedical Science, University of Zambia, Lusaka, Zambia., Mupila Z; Right to Care Zambia, Lusaka, Zambia., Gill CJ; School of Public Health, Department of Global Health, Boston University, Boston, MA, United States of America.
Jazyk:	angličtina
Zdroj:	PeerJ [PeerJ] 2023 May 11; Vol. 11, pp. e15175. Date of Electronic Publication: 2023 May 11 (Print Publication: 2023).
DOI:	10.7717/peerj.15175
Abstrakt:	Pediatric community-acquired pneumonia (CAP) remains a pressing global health concern, particularly in low-resource settings where diagnosis and treatment rely on empiric, symptoms-based guidelines such as the WHO's Integrated Management of Childhood Illness (IMCI). This study details the delivery of IMCI-based health care to 1,320 young infants and their mothers in a low-resource urban community in Lusaka, Zambia during 2015. Our Southern Africa Mother Infant Pertussis Study (SAMIPS) prospectively monitored a cohort of mother/infant pairs across infants' first four months of life, recording symptoms of respiratory infection and antibiotics prescriptions (predominantly penicillins), and tested nasopharyngeal (NP) samples for respiratory syncytial virus (RSV) and Bordetella pertussis . Our retrospective analysis of the SAMIPS cohort found that symptoms and antibiotics use were more common in infants (43% and 15.7%) than in mothers (16.6% and 8%), while RSV and B. pertussis were observed at similar rates in infants (2.7% and 32.5%) and mothers (2% and 35.5%), albeit frequently at very low levels. In infants, we observed strong associations between symptoms, pathogen detection, and antibiotics use. Critically, we demonstrate that non-macrolide antibiotics were commonly prescribed for pertussis infections, some of which persisted across many weeks. We speculate that improved diagnostic specificity and/or clinician education paired with timely, appropriate treatment of pertussis could substantially reduce the burden of this disease while reducing the off-target use of penicillins. Competing Interests: Zacharia Mupila and Lawrence Mwananyanda are employed by Right to Care Zambia. (©2023 Gunning et al.)
Databáze:	MEDLINE
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