Antibiotics for Clinical Dysentery in the Pediatric Emergency Department
Yehonatan Azulai1, Shepard Schwartz2, Eyal Heiman2
1Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Insights
Antibiotic overuse is common for pediatric clinical dysentery diagnoses in the emergency department. This study found most children received antibiotics, despite negative cultures, potentially worsening antibiotic resistance.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Microbiology
Background:
- Clinical dysentery results in significant global mortality.
- Antibiotic use is typically reserved for severe or confirmed shigellosis cases due to rising antibiotic resistance.
- Children with clinical dysentery in pediatric emergency departments (PEDs) receive cautious antibiotic consideration.
Purpose of the Study:
- To investigate the patterns of antibiotic utilization in children diagnosed with clinical dysentery within a pediatric emergency department setting.
Main Methods:
- Retrospective case study analyzing data from 281 children diagnosed with clinical dysentery between 2015 and 2018.
- Comparison of patient demographics, clinical indicators, laboratory culture results, and prescribed antibiotic treatments.
- Evaluation of antibiotic treatment rates in relation to culture-confirmed diagnoses.
Main Results:
- A high proportion of children (83%) diagnosed with clinical dysentery received antibiotic treatment.
- Bacterial cultures were positive in only 58% of cases, with Shigella spp. identified in just 32%.
- Factors associated with antibiotic prescription included younger age, fever, and elevated white blood cell count (leukocytosis).
Conclusions:
- Clinical dysentery is frequently misdiagnosed in pediatric emergency departments, leading to unnecessary antibiotic use.
- Widespread, non-indicated antibiotic treatment contributes to the critical issue of antimicrobial resistance.
- Development of clear clinical guidelines and further research are essential for appropriate antibiotic stewardship in PEDs.
Background:
Clinical dysentery causes hundreds of thousands of deaths annually worldwide. However, current recommendations reserve antibiotics for those either clinically sick or with highly suspected cases of shigellosis. This treatment stems from rising antibiotic resistance. Children diagnosed with clinical dysentery in the pediatric emergency department (PED) are regarded more cautiously.
Objectives:
To explore the use of antibiotics in children diagnosed with clinical dysentery in the PED.
Methods:
A retrospective case study of children with clinical dysentery at a single PED during the years 2015 and 2018. Demographics as well as clinical findings were compared to culture results and antibiotic treatment.
Results:
The study included 281 children who were diagnosed with clinical dysentery during the study period; 234 (83%) were treated with antibiotics. However, cultures were positive in only 162 cases (58%). Only 32% were Shigella spp. Younger age, fever, and leukocytosis were related to antibiotic treatment.
Conclusions:
The diagnosis of clinical dysentery is misgiven commonly in the PED leading to widespread use of antibiotics when not indicated. This treatment may impact antibiotic resistance patterns. Further studies and interventions are necessary to create clear guidelines in the PED setting.
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