2010, Number 6
Therapeutic conduct in children attended in emergency room during the epidemic of influenza A H1N1
Language: Spanish
References: 15
Page: 607-614
PDF size: 45.16 Kb.
ABSTRACT
Objective: to analyze the prescription of antiviral and antibiotic agents in children with upper airway infection (UAI) during Influenza H1N1 epidemic.Methods: a cross-section study (01/04/2009 to 31/ 03/2010) was performed. We analyzed the antiviral and antibiotic agents’ prescription and its relation with the presence of the triad of symptom of suspicion (migraine, fever and cough) and the cost for attention (medicines and screening test).
Results: 838 children were attendance for UAI, 40.3 % with the suspicion triad. In 733 patients, the screening test were done with 155 positive results (120 had the triad). All patient with a positive result received oseltamivir. During the first five months of the epidemic, the medical prescriptions were: antibiotics 60-85 %, 0-7 % anti-viral and 20-30 % symptomatic drug´s. At the 6th at 8th months (peak of outbreak) antibiotics 35-70 %, anti-virals 20-25 % and 10-30 % symptomatic drug´s. At final months (9th to 11th) antimicrobials 65-80 %, antivirals 20-30 % and symptomatic 0-10 %. The cost for URI attention increased a 27 %.
Conclusions: medical prescription changed during the epidemic, with an increased in the antivirals, especially for patients with high suspicion for influenza and positive screening test.
REFERENCES
Bonner AB, Monroe KW, Talley LI, Klasner AE, Kimberlin DW. Impact of the rapid diagnosis of in fluenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics 2003;112(2):363-367. Disponible en http://pediatrics.aappublications.org/cgi/reprint/ 112/2/363
Instituto Mexicano del seguro Social. Guía de práctica clínica, prevención, diagnóstico y tratamiento de la influenza A H1N1. México: Instituto Mexicano del seguro Social; 2009. Disponible en http:// www.imss.gob.mx/NR/rdonlyres/037AA1E9-530E- 4E8B-882F-F8B6EA1D3233/0/GPC_InfluenzaA H1N117092009.pdf
Shun-Shin M, Thompson W, Heneghan C, Perera R, Harnden A, Mant D. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomized controlled trials. BMJ 2009;339:b3172. Disponible en http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC2724601/pdf/bmj.b3172.pdf