UK officials issue draft guidance for acute cough treatment
Draft guidance issued today by the UK National Institute for Health and Care Excellence (NICE) recommends against offering antibiotics for acute cough associated with upper respiratory infection.
In lieu of antibiotics, the guidelines recommended that clinicians advise patients who are not systematically unwell or at risk of higher complications to manage their symptoms with self-care, including honey, the herbal remedy pelargonium, and cough medicines containing the expectorant guaifenesin or the antitussive dextromethorphan (for patients over 12). They also advise clinicians to explain why antibiotics aren't necessary and encourage patients to return if symptoms worsen rapidly or do not improve after 3 to 4 weeks.
For people who are identified at a face-to-face clinical examination as systematically very unwell, the guidelines recommend an immediate prescription of doxycycline (in patients 18 and older) or amoxicillin (in patients under 18). For those identified as having a higher risk of complications, including patients with a pre-existing condition, young children born prematurely, and patients over the age of 65 with prior hospitalization and comorbidities, the guidelines suggest an immediate antibiotic should be considered.
A public comment period on the draft guidance ends on Sep 20. Publication of the new guidelines is expected in February 2019.
Aug 23 NICE draft guideline for acute cough
Multiplex assay reduces antibiotic treatment in kids with CNS infections
A single-center study conducted in Australia found that a cerebrospinal fluid multiplex assay performed on children with a confirmed central nervous system (CNS) infection reduced time to organism identification, antibiotic treatment, and duration of hospitalization, researchers report in the Pediatric Infectious Disease Journal.
The researchers at Australia's Royal Darwin Hospital looked at two cohorts of patients: A 15-month prospective cohort from February 2016 to May 2017 and a 15-month retrospective cohort from November 2014 to February 2016, when the multiplex assay, which can identify up to 14 potential pathogens in cerebrospinal fluid, was introduced. The researchers then compared the time to organism identification and antibiotic management before and after multiplex assay introduction.
Sixty-five cases of pediatric CNS infection were diagnosed over the 30-month period, with 36 diagnosed before the introduction of the assay and 29 diagnosed after. Young infants were the most commonly affected, with 80% of cases occurring in children 3 months or younger. The assay was performed on 26 of the 29 cerebrospinal isolates from children diagnosed as having a CNS infection in the prospective cohort, with enterovirus identified as the most common causative organism (14 children), followed by human parechovirus (4 children). The assay performed with 93.8% sensitivity and 90% specificity when compared with microbiologic culture or reference laboratory results.
After the assay was introduced, the median time to organism identification was reduced from 6 days to 2 days (P < 0.001), median duration of antibiotic therapy fell from 3 days to 2 days (P < 0.001), and median duration of hospitalization fell from 5 days to 3 days (P = 0.016).
The authors of the study say the reduction in the duration of broad-spectrum antibiotic use could reduce short- and long-term adverse drug effects, including disruption of the neonatal gut microbiome. They suggest the multiplex assay could be of most value to hospitals that don't have an onsite molecular laboratory.
September Pediatr Infect Dis J abstract