Questions that parents should ask about antibiotic use in their hospitalized children

Morning MEDtalks with Dr KK Aggarwal

New Delhi, November 18, 2018:

Choosing Wisely: Questions parents should ask about their hospitalized child’s antibiotics: The American Academy of Pediatrics (AAP), as part of the Choosing Wisely® campaign, wants to protect hospitalized children from the effects of antibiotic resistance by providing a list of recommendations to serve as a starting point of conversation for physicians and patients. The five items that physicians and patients should question on the Choosing Wisely List of Antibiotic Stewardship in Hospitalized Children are:

1. Before antibiotics are prescribed, testing of the patient’s blood, urine and other appropriate cultures should be undertaken to confirm suspected invasive bacterial infection.
2. During surgery, the dose and timing of antibiotics to prevent infection are important for optimal effect, and should not be used indiscriminately.
3. Ampicillin is the first choice of treatment for children hospitalized with community-acquired pneumonia who are otherwise healthy and immunized. Broader-spectrum antibiotics, such as cephalosporins, have been shown to contribute to antibiotic resistance and are often unnecessary.
4. Antibiotics such as vancomycin or carbapenems should be avoided unless a child is known to have a specific risk for pathogens that are resistant to other antibiotics.
5. Avoid using prolonged courses of IV antibiotics. For most infections, children respond well to orally administered antibiotics after a brief course of intravenous therapy. Peripherally inserted central catheters, used to facilitate prolonged courses of IV antibiotics, often result in complications.

Multi- and extensively drug-resistant infections, especially Gram-negative infections associated with higher in-hospital mortality rates in India. In an analysis of data from 10 hospitals across India in a retrospective observational study, researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) report that in-hospital mortality is significantly higher among patients infected with multi-drug resistant (MDR) or extensively drug resistant (XDR) pathogens including Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii…(Clinical Infectious Diseases, Nov. 8, 2018).

Beijing issues rare public warning on ‘serious’ swine fever crisis (Beijing): Chinese authorities have announced strict new measures in an attempt to halt the country’s fast-growing African swine fever crisis, which has spread to 18 provinces and led to the culling of more than 200,000 pigs. Days after acknowledging the situation was “serious,” the Chinese Agricultural Ministry on Friday reported the first outbreak of the disease in the southwestern province of Sichuan in a farm of 40 pigs.

The directive called for stricter nationwide inspections of all livestock transportation vehicles, and harsher punishments for the illegal transportation and slaughter of pigs. The document comes after the United Nations recently warned that the disease is “here to stay” in China and could quickly turn into an epidemic, with the most virulent strain of swine fever causing a 100% fatality rate for infected pigs …(CNN).

Sixty-nine percent of respondents in the 9th annual Physicians Practice Great American Physician Survey reported that they would consider going part time. And while about two-thirds (64%) of respondents don’t want to change workplaces, 29% said the main reason why they would prefer to work somewhere else is to work better hours or achieve greater work-life balance. A growing number of respondents (46%) said they would consider becoming a locum tenens physician, suggesting the traditional work environment is no longer as appealing to the 91% of respondents who have been practicing at least 11 years. Today, physicians are increasingly open to the idea that they no longer need to be—or perhaps even want to be—tied to a single employer. Portfolio careers, where physicians have the flexibility to pursue multiple areas of focus and manage multiple revenue streams, are gaining traction. This strategy can provide high levels of job satisfaction, some much-desired mental stimulation, and a good income, too, writes Julie Knudson in Physician Practice.

ADA reaffirms commitment to insulin access and affordability for all—Transparency on Insulin Pricing Critical: On the second anniversary of the Make Insulin Affordable initiative, the American Diabetes Association (ADA) announces that more than 400,000 Diabetes Advocates have joined the call for affordable insulin for all who need it—the largest response to an ADA call to action to date. After its examination of the insulin supply chain, ADA and its Insulin Access and Affordability Working Group (Working Group) published recommendations and public policy solutions to address the problem. The ADA reaffirms its commitment to implementing these solutions and achieving affordable insulin for all who need it… (ADA News Release, Nov.16, 2018)

10 Tips for staying healthy during wildfires (American Thoracic Society)

1. Stay indoors with windows and doors closed.
2. Reduce physical activity.
3. Reduce other sources of indoor air pollution such as smoking cigarettes, using a wood-burning stove or frying meat. Do not vacuum anywhere in the house.
4. Use central air conditioner or filters: A home’s heater set to the fan mode may be able to filter out some of the particles by “re-circulating” the indoor air through the filter.
5. Use air purifiers with HEPA filters. Note: do not use filters that produce ozone such as “super oxygenators.”
6. When traveling in a vehicle, keep windows closed, run the air conditioner and set air to re-circulate to reduce smoke.
7. An N95 or greater mask can help reduce inhalation of particulates if properly fitted. A surgical or simple dust mask will not protect against particulate exposure. None of these masks protect against hazardous gas inhalation.
8. Consider evacuation to areas with lower air quality index for individuals with lung disease (especially those with asthma, COPD / emphysema, pulmonary fibrosis).
9. Create a clean room at home. Use an interior room with fewer doors and windows and run an air conditioner and room air cleaner if available.
10. Patients with asthma or COPD should ensure that they continue to take their maintenance (“controller”) medications or discuss an appropriate regimen with their physician.

The US FDA has expanded the indications for brentuximab vedotin (Adcetris) to include first-line treatment of CD30-expressing peripheral T-cell lymphomas (PTCLs), to be used in combination with chemotherapy.

No association of diabetes and markers of abnormal glucose metabolism with an increased risk for incident knee osteoarthritis. Among older women and men with a high risk of developing knee OA, diabetes status or status fasting glucose or insulin resistance were not associated with odds of incident radiographic knee OA after adjustment for BMI (Arthritis Care & Research, Nov. 12, 2018).

Video to watch: TEDx Video: Doctor-patient relationship www.youtube(dot)com/ watch?v=i9ml1vKK2DQ

Dr KK Aggarwal
Padma Shri Awardee
President Elect CMAAO
President Heart Care Foundation of India