Short courses of antibiotics appear just as effective as longer ones — and a great deal safer — in treating respiratory infections that might cause pneumonia in children on temporary breathing devices, according to a Johns Hopkins Children’s Center study published online May 3 in Clinical Infectious Diseases.
In the study’s analysis of 150 children treated with antibiotics for respiratory infections while on a ventilator, longer antibiotic courses did not only fail to confer extra protection against full-blown pneumonia when compared with shorter therapy, but also considerably increased a child’s risk for developing drug-resistant infections within a month.
To rein in the spread of bacterial drug resistance, the researchers advise clinicians to carefully evaluate the need for antibiotics in the first place and to use antibiotics for the shortest time needed to achieve clinical effect.
“Our study underscores the old physician maxim to first do no harm,” said lead investigator Pranita Tamma, M. D., an infectious disease specialist at Hopkins Children’s. “Longer treatment is not always more effective, and it could be downright dangerous.”
Children on ventilators often develop respiratory infections, or tracheitis, because the breathing tubes allow bacteria an easy entry into the respiratory tract. These children need antibiotics promptly to prevent the infection from spreading into the lungs, but the optimal length of treatment has been unclear.
“We hope that our findings will help clear up some of the confusion and discourage physicians from preemptively opting for longer treatments,” Tamma said.
The Johns Hopkins investigators analyzed three years worth of medical records involving more than 1,600 children, age 18 and younger, who spent at least two days on a breathing tube. Of them, 150 got antibiotics for ventilator-related upper respiratory infections, however only 118 of them met clinical criteria for such infections, and 32 were treated merely on suspicion of infection.
Of the 82 children with actual infections who were treated with antibiotics for more than a week, 23 percent developed pneumonia, compared to 20 percent of the 36 children who got antibiotics for seven days or fewer. However, children who received the lengthy antibiotic course were five times more likely, on average, to develop drug-resistant infections following the treatment. Children who got multiple antibiotics were three times as likely to do so.
Although the length of antibiotic use made no statistical difference in pneumonia risk, the length of intubation did. Children whose tubes were left in after diagnosis of infection and start of therapy were four times more likely to progress to pneumonia than children taken off the ventilator promptly after diagnosis and start of treatment, the researchers found. The finding emphasizes the need for careful daily reassessment of each child’s need to stay on a ventilator, they added.
Past research has shown that more than one-third of antibiotic prescriptions for upper respiratory infections in the intensive care unit may be unwarranted, the investigators noted.
“Beyond fueling drug resistance, antibiotics can cause serious side effects and add to healthcare costs. We, as physicians, should ask ourselves two critical questions any time we prescribe them: ‘Does this patient really need antibiotics?’ If so, ‘what is the shortest course of treatment that will achieve clinical benefit?’” said senior investigator Sara Cosgrove, M.D., an infectious disease specialist at Hopkins.
Other investigators in the study included Alison Turnbull, Ph.D., Aaron Milstone, M.D., M.H.S., Christoph Lehmann, M.D., and Emily Sydnor, M.D., all of Hopkins.
The research was funded by the National Institutes of Health.
Founded in 1912 as the children's hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, with more than 92,000 patient visits and nearly 9,000 admissions each year. Hopkins Children’s is consistently ranked among the top children's hospitals in the nation. Hopkins Children’s is Maryland's largest children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. Hopkins Children's will celebrate its 100th anniversary and move to a new home in 2012. For more information, please visit www.hopkinschildrens.org
Ekaterina Pesheva | EurekAlert!
On track to heal leukaemia
18.01.2017 | Universitätsspital Bern
Penn vet research identifies new target for taming Ebola
12.01.2017 | University of Pennsylvania
Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...
Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.
While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...
Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales
Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...
Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.
As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...
At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).
Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...
10.01.2017 | Event News
09.01.2017 | Event News
05.01.2017 | Event News
18.01.2017 | Power and Electrical Engineering
18.01.2017 | Materials Sciences
18.01.2017 | Life Sciences