News Scan for May 26, 2020

Antibiotic prescribing in French kids
Antibiotic use in Welsh primary care
Probable Ebola infection
H9N2 avian flu case in China
Guinea worm cases in Ethiopia

French study finds high antibiotic use for viral respiratory infections in kids

An assessment of community antibiotic prescribing in French children found high rates of prescribing for viral respiratory tract infections (RTIs) and broad-spectrum antibiotic use, particularly among clinicians 50 years and older, French researchers reported yesterday in the Journal of Antimicrobial Chemotherapy.

The analysis looked at 221,768 pediatric visits in a national sample of 680 French general practitioners (GPs) and 70 community pediatricians from March 2015 to February 2017. The researchers calculated antibiotic prescription rates per 100 visits separately for GP and pediatricians, and assessed broad-spectrum antibiotic use and duration of treatment for RTIs. The results showed that, overall, GPs prescribed more antibiotics than pediatricians, with a prescription rate of 26.1 per 100 visits (95% confidence interval [CI], 25.9 to 26.3) versus 21.6 for pediatricians (95% CI, 21 to 22).

RTIs accounted for more than 80% of antibiotic prescriptions, with presumed viral RTIs being responsible for 40.8% and 23.6% of all antibiotic prescriptions by GPs and pediatricians, respectively. For RTIs, GPs prescribed more broad-spectrum antibiotics than pediatricians (49.8% vs 35.6%), while antibiotic course duration was similar. After adjustment for diagnosis, antibiotic prescribing rates were not associated with season and patient age, but were significantly higher among GPs over 50.

"We suggest that future antibiotic stewardship campaigns should emphasize: zero antibiotic prescribing for presumed viral RTIs (notably bronchitis, common cold and cough), further reducing broad-spectrum antibiotic prescribing and more effective communication towards GPs, especially those older than 50 years of age," the authors wrote.
May 25 J Antimicrob Chemother abstract


Higher antibiotic prescribing found in more deprived areas of Wales

In another study yesterday in the Journal of Antimicrobial Chemotherapy, researchers in Wales reported that antibiotic prescribing is higher among GP practices in poorer parts of the country.

Analyzing data on nearly 3 million patients from 339 GP practices, researchers from Cardiff University found that approximately 9 million oral antibiotics were prescribed from 2013 through 2017. Antibiotic prescribing rates per person varied by levels of socioeconomic status (SES), with the rate in the most deprived areas of the country being 26% higher than in the least deprived. The association between deprivation and antibiotic prescribing persisted after controlling for demographic variables, smoking, chronic conditions, and clustering by GP practice and GP cluster. Those living in areas in the most deprived quintile in Wales received 18% more antibiotic prescriptions (incidence rate ratio [IRR], 1.18; 95% CI, 1.18 to 1.19) than those with similar demographics, chronic conditions and smoking status but living in areas in the least deprived quintile.

The authors of the study say the higher prescribing rates seen in more deprived areas could be because people in lower SES groups consult healthcare providers more frequently and may consult more frequently for infections. In addition, prescribers could be more concerned about increased risk of complications in this group. They say the findings may be generalizable to other countries with similar settings and healthcare delivery systems.
May 25 J Antimicrob Chemother abstract


Retrospective probable case added to DRC Ebola total

Though no new confirmed cases have been reported in the Democratic Republic of the Congo (DRC) over the past 29 days, on May 22 health officials added one probable retrospective case, according to the latest weekly outbreaks and emergencies report from the World Health Organization (WHO) African regional office.

The probable retrospective case involves a patient from Mabalako, raising the overall case count to 3,463 and the number of probable cases to 146. The fatality count is 2,280.

The DRC is in the midst of a 42-day countdown until the outbreak is considered over, following a cluster of seven cases, four of them fatal, reported in the middle of April. One of the patients was lost to follow-up on May 16 after leaving a temporary isolation facility.

The WHO said efforts are still under way to find the patient and to investigate the source of the recent cluster. It said the long duration and large size of the outbreak—which began in August 2018—underscore the re-emergence risk and added that it's important to maintain strong surveillance to detect, isolate, test, and treat new suspected case-patients.
May 25 WHO African regional office weekly report


H9N2 avian flu infects 2 children in China

China has detected two more H9N2 avian flu infections, both involving children, according to a statement from Taiwan Centers for Disease Control, translated and posted by Avian Flu Diary (AFD).

One of the patients is a 6-year-old boy from the city of Weihai in Shandong province in eastern China, and the other is a 10-month-old boy from Xiamen in Fujian province, which is located in the southeast. Both boys had a history of contact with live poultry or poultry markets before they got sick. Their symptoms were mild, and they have since recovered.

Taiwan officials said seven H9N2 cases have been reported from the mainland since October 2019. The World Health Organization has said H9N2 is enzootic in Asian poultry. Human infections are rare, but when they do occur, children are more likely to be affected, and illnesses are typically mild.
May 25 AFD post


Ethiopia detects seven suspected Guinea worm infections

Ethiopia reported to the WHO seven suspected cases of human Guinea worm infections (dracunculiasis) detected in early April in the Gog district of the Gambella region.

The infections come more than 2 years after the last human Guinea worm cases were detected in that country.

"All the infected people used unsafe drinking water from farm ponds. These water sources were reported to be associated with the baboon infection in June 2019 in the same village," the WHO said. Worm specimens have been sent to the US Centers for Disease Control and Prevention for confirmation.
May 25 WHO update

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