Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study.
OBJECTIVE
To determine how well antibiotic treatment is targeted by simple clinical syndromes and to what extent drug resistance threatens affordable antibiotics.


METHODS
Observational study involving a priori definition of a hierarchy of syndromic indications for antibiotic therapy derived from World Health Organization integrated management of childhood illness and inpatient guidelines and application of these rules to a prospectively collected dataset.


METHODS
Kilifi District Hospital, Kenya.


METHODS
11,847 acute paediatric admissions.


METHODS
Presence of invasive bacterial infection (bacteraemia or meningitis) or Plasmodium falciparum parasitaemia; antimicrobial sensitivities of isolated bacteria.


RESULTS
6254 (53%) admissions met criteria for syndromes requiring antibiotics (sick young infants; meningitis/encephalopathy; severe malnutrition; very severe, severe, or mild pneumonia; skin or soft tissue infection): 672 (11%) had an invasive bacterial infection (80% of all invasive bacterial infections identified), and 753 (12%) died (93% of all inpatient deaths). Among P falciparum infected children with a syndromic indication for parenteral antibiotics, an invasive bacterial infection was detected in 4.0-8.8%. For the syndrome of meningitis/encephalopathy, 96/123 (76%) isolates were fully sensitive in vitro to penicillin or chloramphenicol.


CONCLUSIONS
Simple clinical syndromes effectively target children admitted with invasive bacterial infection and those at risk of death. Malaria parasitaemia does not justify withholding empirical parenteral antibiotics. Lumbar puncture is critical to the rational use of antibiotics.
Berkley
James A
JA
Centre for Geographic Medicine Research (coast), PO Box 230, Kilifi, Kenya. jberkley@kilifi.mimcom.net
Maitland
Kathryn
K
Mwangi
Isaiah
I
Ngetsa
Caroline
C
Mwarumba
Saleem
S
Lowe
Brett S
BS
Newton
Charles R J C
CR
Marsh
Kevin
K
Scott
J Anthony G
JA
English
Mike
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D016638:Critical Illness; D024881:Drug Resistance, Bacterial; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications*; D018512:Parasitemia / Q000150:complications; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013129:Spinal Puncture; D013577:Syndrome
D000900:Anti-Bacterial Agents