tetano
Editor, Senior Moderator
Paediatr Int Child Health. 2015 Aug 20:2046905515Y0000000052. [Epub ahead of print]
[h=1]The validity of clinical practice guidelines for empirical use of oseltamivir for influenza in Thai children.[/h] Wongsawat J, Chittaganpitch M, Aumpornareekul S, Srisopa S, Likanonsakul S.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Clinical practice guidelines for influenza have been implemented to maximise the appropriate use of empirical oseltamivir; however, good predictive values are required.
[h=4]METHODS:[/h] Between October 2011 and September 2013, children aged < 15 years who presented at the Bamrasnaradura Infectious Diseases Institute with an influenza-like illness plus either (i) pneumonia or (ii) being in a higher risk group for influenza complications were prospectively enrolled. Respiratory specimens were taken for real-time polymerase chain reaction testing (RT-PCR). Clinical characteristics, laboratory data and oseltamivir therapy were recorded.
[h=4]RESULTS:[/h] 85 cases were enrolled. Of these, the proportions of those with pneumonia, who were aged < 2 years and who had underlying diseases were 74.1%, 56.5% and 38.8%, respectively. RT-PCR detected respiratory syncytial virus (35.3%), influenza (22.3%), adenovirus (14.1%), human metapneumovirus (5.9%), para-influenza (3.5%) and no viruses (25.9 %). Pneumonia (OR 0.16, 95% CI 0.05-0.50) and having two clinical criteria (OR 0.24, 95% CI 0.08-0.76) were significantly negative predictors for influenza. Having cluster transmissions (OR 5.18, 95% CI 1.38-19.37) and a monocyte proportion >7% (OR 3.58, 95% CI 1.15-11.17) were significantly positive predictors of influenza. The mean (SD) percentage of influenza-like illness during the study period was 7.04 (2.02).
[h=4]CONCLUSIONS:[/h] Clinical criteria guidelines yielded a low predictive value (22.3%) for influenza among children. Seasonality, cluster transmission, white blood cell and differential counts may be helpful in diagnosing influenza. Nonetheless, empirical oseltamivir should not be delayed for those in need.
[h=4]KEYWORDS:[/h] Empirical oseltamivir; Higher risk groups for influenza complications,; Lower respiratory tract viral infections,; Pneumonia,
PMID: 26293663 [PubMed - as supplied by publisher]
[h=1]The validity of clinical practice guidelines for empirical use of oseltamivir for influenza in Thai children.[/h] Wongsawat J, Chittaganpitch M, Aumpornareekul S, Srisopa S, Likanonsakul S.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Clinical practice guidelines for influenza have been implemented to maximise the appropriate use of empirical oseltamivir; however, good predictive values are required.
[h=4]METHODS:[/h] Between October 2011 and September 2013, children aged < 15 years who presented at the Bamrasnaradura Infectious Diseases Institute with an influenza-like illness plus either (i) pneumonia or (ii) being in a higher risk group for influenza complications were prospectively enrolled. Respiratory specimens were taken for real-time polymerase chain reaction testing (RT-PCR). Clinical characteristics, laboratory data and oseltamivir therapy were recorded.
[h=4]RESULTS:[/h] 85 cases were enrolled. Of these, the proportions of those with pneumonia, who were aged < 2 years and who had underlying diseases were 74.1%, 56.5% and 38.8%, respectively. RT-PCR detected respiratory syncytial virus (35.3%), influenza (22.3%), adenovirus (14.1%), human metapneumovirus (5.9%), para-influenza (3.5%) and no viruses (25.9 %). Pneumonia (OR 0.16, 95% CI 0.05-0.50) and having two clinical criteria (OR 0.24, 95% CI 0.08-0.76) were significantly negative predictors for influenza. Having cluster transmissions (OR 5.18, 95% CI 1.38-19.37) and a monocyte proportion >7% (OR 3.58, 95% CI 1.15-11.17) were significantly positive predictors of influenza. The mean (SD) percentage of influenza-like illness during the study period was 7.04 (2.02).
[h=4]CONCLUSIONS:[/h] Clinical criteria guidelines yielded a low predictive value (22.3%) for influenza among children. Seasonality, cluster transmission, white blood cell and differential counts may be helpful in diagnosing influenza. Nonetheless, empirical oseltamivir should not be delayed for those in need.
[h=4]KEYWORDS:[/h] Empirical oseltamivir; Higher risk groups for influenza complications,; Lower respiratory tract viral infections,; Pneumonia,
PMID: 26293663 [PubMed - as supplied by publisher]