Study probes increasing use of cefdinir in Kentucky children
A review of Medicaid claims in Kentucky from 2012 through 2016 found that cefdinir prescriptions for treating outpatient pediatric infections has increased over the study period, researchers based at the University of Kentucky reported today in the Journal of the Pediatric Infectious Diseases Society.
Cefdinir is an oral third-generation cephalosporin that, despite its ease of prescribing in children, isn't recommended as first-line therapy because of pharmacokinetics concerns and unnecessarily broad and mismatched coverage. The authors looked at cefdinir prescribing patterns as part of an effort to understand why Kentucky has the highest rate of antibiotic prescribing for children. The researchers had previously found an overall decrease in antibiotic use in Kentucky; however, the number of cefdinir prescriptions rose over that period.
In the current study, the researchers linked pharmacy claims to medical claims to better understand diagnoses related to cefdinir use. Of 3.6 million antibiotic prescriptions filled over the 5-year study period, 10% were for cefdinir, which led to a cost of $18 million—22% of all Medicaid antibiotic spending. Rates of use rose from 140 per 1,000 children in 2012 to 209 per 1,000 in 2016. During the same timeframe, amoxicillin use was stable and rates of azithromycin and amoxicillin-clavulanate declined.
Upper respiratory infections accounted for most cefdinir use, and the team saw a shift toward higher prescribing in young children and provider type from physicians to nurse practitioners, consistent with overall antibiotic prescribing in Kentucky's Medicaid recipients.
Given that much of the use was probably inappropriate and that the drug is costly, the authors wrote, "Cefdinir is the ideal target for outpatient stewardship; it is both inappropriately prescribed and also expensive, so reducing use may lead to better patient care as well as substantial cost savings.
Dec 11 J Pediatric Infect Dis Soc abstract
Colistin resistance MCR genes found in Ecuador, China clusters
In the latest in colistin resistance genes, Ecuadorian researchers yesterday reported a household animal-human cluster of MCR-1, and Chinese investigators today report a cluster of colistin- and carbapenem-resistant Klebsiella pneumoniae carrying both NDM-1 and MCR-8 resistance genes.
In the first study, published in the Journal of Global Antimicrobial Resistance, the scientists attempted to detect possible sources of colistin-resistant Escherichia coli after a boy was determined to have Ecuador's first case of MCR-1–containing E coli carriage. They collected fecal swabs and soil fecal samples from domestic animals in the boy's home.
The researchers found MCR-1.1 in three isolates, from two dogs and a chicken. The three isolates were on three different E coli sequence types, and the human isolate was found on a fourth sequence type.
The authors conclude, "Our results indicate a polyclonal dissemination of mcr-1.1 in the environment surrounding the first MCR-producing E. coli strain reported in Ecuador."
Dec 10 J Glob Antimicrob Resist study
In the second study, researchers in Chengdu, the capital of Sichuan province, detail a cluster of five carbapenem-resistant K pneumoniae strains from patients in two hospitals, four of which were also resistant to colistin. The findings appear in the Journal of Infectious Diseases.
Whole-genome sequencing identified NDM-1 (New Delhi metal-beta-lactamase), which confers resistance to carbapenem antibiotics. The four colistin-resistant strains harbored a new variant of MCR-8, called MCR-8.2, which differs from MCR-8.1 by four amino acid substitutions. The authors say the findings represent an emerging threat for clinical management.
Dec 11 J Infect Dis abstract