RESUMO
Introducción. A pesar de que la mayoría de las neumonías en menores de 5 años son virales, en la práctica diaria, frecuentemente, son tratadas con antibióticos. Una regla clínica de decisión (BPS: Bacterial Pneumonia Score) demostró ser eficaz para identificar qué niños con neumonía requerían antibióticos, pero su desempeño no ha sido evaluado en la población vacunada contra neumococo. El objetivo fue evaluar si el empleo del BPS permitía un menor uso de antibióticos comparado con el manejo habitual en niños con neumonía adquirida en la comunidad, que recibieron vacunación antineumocóccica. Material y método. Ensayo clínico controlado, aleatorizado, de grupos paralelos, con enmascaramiento parcial, que compara dos métodos de manejo de niños de 3-60 meses de edad asistidos ambulatoriamente por neumonía, que hubieran recibido vacuna antineumocóccica conjugada. El Grupo BPS recibió antibióticos con BPS > 4 puntos; el grupo control recibió antibióticos según criterio del médico tratante. El tamaño muestral calculado contempló, al menos, 30 pacientes por grupo. Se comparó la proporción de uso de antibióticos y la evolución clínica en ambos grupos. Resultados. Se incluyeron 65 pacientes (33 en el grupo BPS y 32 en el grupo control), con edad promedio de 17,5 meses. El empleo de antibióticos fue significativamente mayor en el grupo control que en el grupo BPS (21/32 vs. 9/33; OR 5,09; IC 95%: 1,57-16,85; p = 0,001). Se observó una mala evolución en 7 pacientes (3 del grupo BPS y 4 del grupo control). Conclusión. El empleo de BPS permitió un menor uso de antibióticos para el manejo inicial de pacientes con neumonía vacunados contra neumococo, sin aumentar el riesgo de mala evolución.(AU)
Introduction. Although most cases of pneumonia in children younger than 5 years old have a viral nature, in everyday practice, they are frequently treated with antibiotics. A clinical decision rule (BPS:Bacterial Pneumonia Score) proved to be effective for identifying which children with pneumonia required antibiotics, but its performance has not been assessed in the population vaccinated against pneumococcal disease. Our objective was to assess whether using the BPS would allow to reduce antibiotic use compared to routine management of children with community acquired pneumonia vaccinated against pneumococcal disease. Material and Methods. Randomized, controlled, partially-blinded clinical trial with parallel groups comparing two approaches in the management of children aged 3-60 months old in an outpatient setting because of pneumonia, who had been vaccinated with the pneumococcal conjugate vaccine.The BPS group received antibiotics with a BPS >4 points; while the control group was administered antibiotics at the discretion of the treating physician. The estimated sample size was calculated as, at least, 30 patients per group. The rate of antibiotic use and the clinical course were compared in both groups. Results. Sixty-five patients (33 in the BPS group and 32 in the control group) were included; their average age was 17.5 months old. Antibiotic use was significantly higher in the control group than in the BPS group (21/32 versus 9/33; OR: 5.09; 95% CI: 1.57-16.85; p= 0.001). Seven patients had an unfavorable course (three in the BPS group, and four in the control group). Conclusion. The use of the BPS allowed to reduce antibiotic use in the initial management of patients with pneumonia vaccinated against pneumococcal disease, without increasing the probability of an unfavorable course of the disease.(AU)
RESUMO
Introducción. A pesar de que la mayoría de las neumonías en menores de 5 años son virales, en la práctica diaria, frecuentemente, son tratadas con antibióticos. Una regla clínica de decisión (BPS: Bacterial Pneumonia Score) demostró ser eficaz para identificar qué niños con neumonía requerían antibióticos, pero su desempeño no ha sido evaluado en la población vacunada contra neumococo. El objetivo fue evaluar si el empleo del BPS permitía un menor uso de antibióticos comparado con el manejo habitual en niños con neumonía adquirida en la comunidad, que recibieron vacunación antineumocóccica. Material y método. Ensayo clínico controlado, aleatorizado, de grupos paralelos, con enmascaramiento parcial, que compara dos métodos de manejo de niños de 3-60 meses de edad asistidos ambulatoriamente por neumonía, que hubieran recibido vacuna antineumocóccica conjugada. El Grupo BPS recibió antibióticos con BPS > 4 puntos; el grupo control recibió antibióticos según criterio del médico tratante. El tamaño muestral calculado contempló, al menos, 30 pacientes por grupo. Se comparó la proporción de uso de antibióticos y la evolución clínica en ambos grupos. Resultados. Se incluyeron 65 pacientes (33 en el grupo BPS y 32 en el grupo control), con edad promedio de 17,5 meses. El empleo de antibióticos fue significativamente mayor en el grupo control que en el grupo BPS (21/32 vs. 9/33; OR 5,09; IC 95%: 1,57-16,85; p = 0,001). Se observó una mala evolución en 7 pacientes (3 del grupo BPS y 4 del grupo control). Conclusión. El empleo de BPS permitió un menor uso de antibióticos para el manejo inicial de pacientes con neumonía vacunados contra neumococo, sin aumentar el riesgo de mala evolución.
Introduction. Although most cases of pneumonia in children younger than 5 years old have a viral nature, in everyday practice, they are frequently treated with antibiotics. A clinical decision rule (BPS:Bacterial Pneumonia Score) proved to be effective for identifying which children with pneumonia required antibiotics, but its performance has not been assessed in the population vaccinated against pneumococcal disease. Our objective was to assess whether using the BPS would allow to reduce antibiotic use compared to routine management of children with community acquired pneumonia vaccinated against pneumococcal disease. Material and Methods. Randomized, controlled, partially-blinded clinical trial with parallel groups comparing two approaches in the management of children aged 3-60 months old in an outpatient setting because of pneumonia, who had been vaccinated with the pneumococcal conjugate vaccine.The BPS group received antibiotics with a BPS >4 points; while the control group was administered antibiotics at the discretion of the treating physician. The estimated sample size was calculated as, at least, 30 patients per group. The rate of antibiotic use and the clinical course were compared in both groups. Results. Sixty-five patients (33 in the BPS group and 32 in the control group) were included; their average age was 17.5 months old. Antibiotic use was significantly higher in the control group than in the BPS group (21/32 versus 9/33; OR: 5.09; 95% CI: 1.57-16.85; p= 0.001). Seven patients had an unfavorable course (three in the BPS group, and four in the control group). Conclusion. The use of the BPS allowed to reduce antibiotic use in the initial management of patients with pneumonia vaccinated against pneumococcal disease, without increasing the probability of an unfavorable course of the disease.
Assuntos
Humanos , Lactente , Pré-Escolar , Infecções Pneumocócicas/prevenção & controle , Resultado do Tratamento , Pneumonia Bacteriana/tratamento farmacológico , Vacinas Pneumocócicas , Tomada de Decisão Clínica , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêuticoRESUMO
INTRODUCTION: Although most cases of pneumonia in children younger than 5 years old have a viral nature, in everyday practice, they are frequently treated with antibiotics. A clinical decision rule (BPS:Bacterial Pneumonia Score) proved to be effective for identifying which children with pneumonia required antibiotics, but its performance has not been assessed in the population vaccinated against pneumococcal disease. Our objective was to assess whether using the BPS would allow to reduce antibiotic use compared to routine management of children with community acquired pneumonia vaccinated against pneumococcal disease. MATERIAL AND METHODS: Randomized, controlled, partially-blinded clinical trial with parallel groups comparing two approaches in the management of children aged 3-60 months old in an outpatient setting because of pneumonia, who had been vaccinated with the pneumococcal conjugate vaccine.The BPS group received antibiotics with a BPS >4 points; while the control group was administered antibiotics at the discretion of the treating physician. The estimated sample size was calculated as, at least, 30 patients per group. The rate of antibiotic use and the clinical course were compared in both groups. RESULTS: Sixty-five patients (33 in the BPS group and 32 in the control group) were included; their average age was 17.5 months old. Antibiotic use was significantly higher in the control group than in the BPS group (21/32 versus 9/33; OR: 5.09; 95% CI: 1.57-16.85; p= 0.001). Seven patients had an unfavorable course (three in the BPS group, and four in the control group). CONCLUSION: The use of the BPS allowed to reduce antibiotic use in the initial management of patients with pneumonia vaccinated against pneumococcal disease, without increasing the probability of an unfavorable course of the disease.