Algorithm may aid appropriate antibiotic prescribing for kids with diarrhea
A randomized trial of children with diarrhea in two low-income countries found that use of an algorithm to predict the likelihood of viral etiology resulted in reduced antibiotic use in children who had a higher likelihood of viral illness, researchers reported today in JAMA Pediatrics.
To determine whether the diarrheal etiology prediction (DEP) algorithm improves prescribing in children with acute diarrhea, an international team of researchers conducted a randomized crossover study at 7 government hospitals in Bangladesh (3 sites) and Mali (4 sites). Physicians enrolled in the study were randomized into an intervention arm in which the DEP, which calculates the probability of viral etiology of diarrhea based on patient-specific and location-specific features, was incorporated into smartphone-based electronic clinical decision support tool (eCDS with the DEP), and a control arm (eCDS without DEP) for 4 weeks, followed by a 1-week washout period and 4-week crossover period. The primary outcome was the proportion of children who received an antibiotic.
A total of 30 physicians and 941 patients (57.1% male; median age, 12 months) were enrolled. Overall, 309 (69.8%) children in the DEP arm were prescribed antibiotics, compared with 381 (76.5%) in the control arm.
There was no evidence of a statistically significant difference in the proportion of children prescribed antibiotics by physicians using the DEP (risk difference [RD], −4.2%; 95% confidence interval [CI], −10.7% to 1.0%). A post hoc analysis, however, found that, in children who had a higher predicted probability of viral-only diarrhea, there was a small but statistically significant difference in risk of antibiotic prescription between the DEP and control arms (RD, −0.056; 95% CI, −0.128 to −0.01). No known adverse effects of the DEP were detected 10 days after discharge.
The study authors say the post hoc analysis suggests that providing physicians with an estimated probability of the cause of diarrheal illness can improve appropriateness of antibiotic use, particularly in low-resource settings where antibiotic treatment for diarrhea rarely follows international guidelines.
"These findings represent a technical and behavioral proof-of-concept that a probability-based eCDS in resource-limited settings can impact antibiotic use in pediatric patients," they wrote.
Aug 29 JAMA Pediatr study
High-path avian flu hits more poultry in 3 states, including 2 farms
Three states reported more highly pathogenic avian influenza outbreaks in poultry, including California, where the virus struck two commercial flocks, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).
In California, outbreaks occurred at a turkey farm housing 161,000 birds in Tuolumne County, located in the central part of the state, and a broiler breeding farm that has 34,800 birds in Fresno County. Also, the APHIS recently reported an event involving a backyard flock in Contra Costa County.
Elsewhere, APHIS reported more outbreaks in backyard birds in Utah and Washington. Utah's outbreak occurred in Webster County at a location that had 20 birds. Washington reported two similar outbreaks, one in Cowlitz County and the other in Pierce County.
So far, the outbreaks involving the Eurasian H5N1 strain have led to the loss of 40.3 million birds across 39 states.
Meanwhile, outbreaks in wild birds have also continued, and APHIS recently reported 12 more detections, raising the total to 2,116. Most of the new detections were waterfowl found dead in Oregon.
USDA APHIS poultry outbreak updates
USDA APHIS wild bird detection updates
In international developments, Russia reported another H5N1 outbreak in village geese and poultry in Chelyabinsk oblast, located in the west central part of the country near the Ural Mountains. According to the World Organization for Animal Health (WOAH), the outbreak began on Aug 17, killing 87 of 2,023 birds.
Aug 29 WOAH report
