Despite widespread recommendations for use among kids at risk for complications from influenza infection, including children under 5 years and those with certain underlying medical conditions, antivirals were prescribed for only one-third of at-risk children, according to a study based on data from the New Vaccine Surveillance Network from 2016 to 2020. 

The study was published yesterday in Influenza and Other Respiratory Viruses. It included information on children presenting to the emergency department (ED) with confirmed flu at one of seven pediatric academic centers. Characteristics of children prescribed antivirals were compared to those who were not.

In total, 2,472 children enrolled in the study tested positive for influenza, of which 1,931 (78%) were at high risk for severe flu. Of those at risk, 622 (32%) received an antiviral. Oseltamivir (Tamiflu) was the only antiviral prescribed.
 

Clinical testing associated with antiviral use 

Children prescribed an antiviral had a shorter duration of symptoms (2 days) before presenting to the ED than those not prescribed the drug. Older children were less likely to be prescribed antivirals, and significant differences in prescribing were seen across several states. 

The factor most associated with antiviral use was clinical testing. Children who underwent clinical testing for flu had higher odds of being prescribed antivirals than those who did not (adjusted odds ratio, 18.10; 95% confidence interval, 12.97 to 25.25).

Influenza antivirals for children continue to be under-prescribed in the ED, including for children at higher risk of severe influenza.

“Influenza antivirals for children continue to be under-prescribed in the ED, including for children at higher risk of severe influenza,” the authors concluded. “Our study highlights the concerning gap in evidence-based influenza treatment of children in the ED setting, similar to that in hospitalized children with influenza, and underscores the need for implementation research to increase adherence.”

Antibiotic exposure during pregnancy or early childhood is associated with increased risk of childhood atopic dermatitis (AD), according to a study published yesterday in eClinicalMedicine.

In a review and meta-analysis, Chinese researchers examined 39 cohort studies involving expectant mothers and young children younger than 5 years old to explore the association between antibiotic exposure and the risk of childhood AD, a chronic skin condition characterized by inflammation, eczema-like lesions, and severe itching. 

While studies in mice have suggested that antibiotics can induce AD-like pathology, clinical studies and meta-analyses have reported inconsistent results in children who've had early antibiotic exposure. 

The meta-analysis of the 39 studies, which involved more than 7.4 million children, found that antibiotic exposure was associated with a 22% increased risk of childhood AD (pooled odds ratio [OR], 1.22; 95% confidence interval [CI], 1.17 to 1.28). Subgroup analysis showed that early childhood exposure to antibiotics demonstrated a stronger association with AD (OR, 1.23; 95% CI, 1.13 to 1.34) compared with exposure during pregnancy (OR, 1.09; 95% CI, 1.05 to 1.13). 

Antibiotic exposure frequency, antibiotic type may play a role

Further subgroup analyses revealed that increased risk of AD following antibiotic exposure was affected by the diagnostic criteria of AD, that increased risk of AD was higher in American/European children than Asian children, and that both the antibiotic exposure frequency and type of antibiotic appear to influence the increased risk of AD.

"Taken together, our study supports that antibiotic exposure during pregnancy and early childhood increases the risk of AD," the study authors wrote.

The authors caution that because of the presence of biases in the reviewed studies (such as selection and publication bias) and uncontrolled confounding factors, more high-quality studies with larger sample sizes are needed.

"Future studies should consider variables including different types and dosages of antibiotic exposure, the influence of breast milk, specific conditions in rural areas, and medication compliance," they concluded.

A decline in the sale of antibiotics for use in food-producing animals in the United Kingdom was associated with a significant decrease in indicators of antimicrobial resistance (AMR) in pigs and poultry, researchers reported last week in the Journal of Antimicrobial Chemotherapy.

From 2014 through 2021, antibiotic sales for food-producing animals in the United Kingdom were cut in half, declining from 59.27 milligrams per population correction unit (mg/PCU) to 29.14 mg/PCU. The decrease was spurred by 2014 report from the UK government that called for reductions in the use of antibiotics in humans and animals. 

To analyze associations between the decrease and AMR in food-producing animals, researchers from the UK's Animal and Plant Health Agency and Veterinary Medicines Directorate assessed the prevalence of non–wild-type Escherichia coli (strains that have acquired resistance) in pigs and poultry (broilers and turkeys)—the sectors that have contributed the most to the reductions in antibiotic sales.

Significant drop in resistant E coli

Over the study period, the percentage of non–wild-type E coli isolates with resistance to any antibiotic tested (the primary AMR indicator) fell from 82% to 61%, and the percentage of isolates showing multidrug resistance (the secondary indicator) fell from 56% to 31%. 

Logistic regression models showed a significant association between decreasing antimicrobial sales and declines in the percentage of any non–wild-type E coli (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.70 to 4.27) and declines in the percentage of E coli displaying multidrug resistance (OR, 2.58; 95% CI, 1.78 to 3.74).

Although analysis of the direct impact of the findings on human health in the United Kingdom was beyond the scope of the study, the study authors note previous studies have shown links between food-animal antibiotic use and resistant E coli in people.

"Sustaining efforts of antimicrobial stewardship, together with ongoing surveillance, will be important to maintain progress in the control of AMR," the authors wrote. "To further reduce the spread of AMR, funding other areas of research will be beneficial, such as investigating best farm practices (while supporting animal welfare standards, which in itself can affect disease resilience) at [the] individual-farm level."

A 2022 survey of more than 1,000 healthcare providers (HCPs) at US college medical centers reveals that less than half routinely check the human papillomavirus (HPV) vaccination histories of most female patients.

Last week in BMC Public Health, University of Rhode Island-led researchers described their survey of 1,159 nurse practitioners (NPs), physicians, and physician assistants about their HPV screening practices for women.

Two HPV vaccine doses are recommended for all children aged 9 to 15 years, while three are advised for older adolescents and adults up to age 26 (female and male).

The authors noted that while HPV vaccination is highly effective in preventing infection and related precancers and invasive cancers, the United States falls short of national and global vaccination targets. "College students are an important audience for catch-up vaccination given suboptimal population coverage in adolescents," they wrote.

College policy tied to higher screening rate

Of all respondents, 45% reported routinely screening the HPV vaccination histories of at least 70% of women. NPs were 1.3 times more likely than other providers to routinely check HPV vaccination status. 

College health centers are uniquely positioned to help promote completion of the recommended HPV vaccine series and reduce the risk of future HPV-related cancers and other sequelae.

Multivariable logistic regression modeling showed a link between regular HPV vaccination screening and positive HCP attitudes, HCP self-efficacy toward screening, larger institution size, recent training, and electronic health record prompts. In addition, HCPs whose health center required HPV vaccination screening were 2.4 times more likely to report consistent screening than those without a policy.

"College health centers are uniquely positioned to help promote completion of the recommended HPV vaccine series and reduce the risk of future HPV-related cancers and other sequelae," the researchers wrote. "Future studies should examine whether all students, including male and nonbinary/transgender students, are being screened for HPV vaccination history and offered HPV vaccination in college health settings."

"Provider attitudes and beliefs and organizational policies and trainings that are found to facilitate the uptake of routine screening of HPV vaccination status should be incorporated into the design of theory-based, tailored interventions to promote the routine screening of HPV vaccination status among all college students," they concluded.