Judicious Use of Antibiotics and Radiologic Imaging in Diagnosis and Management of Pediatric Upper Respiratory Tract Infections

Abstract

A considerable amount of effort has been put into the reduction of the overuse of antibiotics and reduction in radiographic studies in the pediatric population. Infections within the ear, nose, and throat and in cervical regions are a frequent source of antibiotic use in children. Quality improvement projects creating clear care pathways have been important to delineate which imaging may be most helpful.

Keywords

CT scan - antimicrobial stewardship - deep neck infection

• References

• 1 Fleming-Dutra KE, Hersh AL, Shapiro DJ. , et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016; 315 (17) 1864-1873
• 2 Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US emergency department visits for outpatient adverse drug events, 2013-2014. JAMA 2016; 316 (20) 2115-2125
• 3 The White House. National action plan for combating antibiotic-resistant bacteria. Available at: https://www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf . Accessed January 15, 2018
• 4 Paschke AA, Zaoutis T, Conway PH, Xie D, Keren R. Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children. Pediatrics 2010; 125 (04) 664-672
• 5 Goossens H, Ferech M, Coenen S, Stephens P. ; European Surveillance of Antimicrobial Consumption Project Group. Comparison of outpatient systemic antibacterial use in 2004 in the United States and 27 European countries. Clin Infect Dis 2007; 44 (08) 1091-1095
• 6 Hicks LA, Bartoces MG, Roberts RM. , et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis 2015; 60 (09) 1308-1316
• 7 Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics 2011; 128 (06) 1053-1061
• 8 Gerber JS, Prasad PA, Russell Localio A. , et al. Variation in antibiotic prescribing across a pediatric primary care network. J Pediatric Infect Dis Soc 2015; 4 (04) 297-304
• 9 Pichichero ME. Diagnostic accuracy of otitis media and tympanocentesis skills assessment among pediatricians. Eur J Clin Microbiol Infect Dis 2003; 22 (09) 519-524
• 10 Pichichero ME. Diagnostic accuracy, tympanocentesis training performance, and antibiotic selection by pediatric residents in management of otitis media. Pediatrics 2002; 110 (06) 1064-1070
• 11 Wald ER, Applegate KE, Bordley C. , et al; American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics 2013; 132 (01) e262-e280
• 12 DeMuri GP, Gern JE, Moyer SC, Lindstrom MJ, Lynch SV, Wald ER. Clinical features, virus identification, and sinusitis as a complication of upper respiratory tract illness in children ages 4-7 years. J Pediatr 2016; 171: 133-9.e1
• 13 Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core elements of outpatient antibiotic stewardship. MMWR recommendations and reports. Morbidity Mortality Weekly Report Recommendations Reports 2016; 65: 1-12
• 14 Gerber JS, Prasad PA, Fiks AG. , et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA 2013; 309 (22) 2345-2352
• 15 Meeker D, Knight TK, Friedberg MW. , et al. Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial. JAMA Intern Med 2014; 174 (03) 425-431
• 16 Clausen TD, Bergholt T, Bouaziz O. , et al. Broad-Spectrum antibiotic treatment and subsequent childhood type 1 diabetes: a Nationwide Danish Cohort Study. PLoS One 2016; 11 (08) e0161654
• 17 Horton DB, Scott FI, Haynes K. , et al. Antibiotic Exposure and Juvenile Idiopathic Arthritis: A Case-Control Study. Pediatrics 2015; 136 (02) e333-e343
• 18 Hirsch AG, Pollak J, Glass TA. , et al. Early-life antibiotic use and subsequent diagnosis of food allergy and allergic diseases. Clin Exp Allergy 2017; 47 (02) 236-244
• 19 Miglioretti DL, Johnson E, Williams A. , et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013; 167 (08) 700-707
• 20 Lodwick DL, Cooper JN, Kelleher KJ, Brilli R, Minneci PC, Deans KJ. Variation in utilization of computed tomography imaging at tertiary pediatric hospitals. Pediatrics 2015; 136 (05) e1212-e1219
• 21 Atabaki SM, Hoyle Jr JD, Schunk JE. , et al. Comparison of prediction rules and clinician suspicion for identifying children with clinically important brain injuries after blunt head trauma. Acad Emerg Med 2016; 23: 566-575
• 22 Stanley RM, Hoyle Jr JD, Dayan PS. , et al. Emergency department practice variation in computed tomography use for children with minor blunt head trauma. J Pediatr 2014; 165: 1201-1206
• 23 Nigrovic LE, Schunk JE, Foerster A. , et al; Traumatic Brain Injury Group for the Pediatric Emergency Care Applied Research Network. The effect of observation on cranial computed tomography utilization for children after blunt head trauma. Pediatrics 2011; 127 (06) 1067-1073
• 24 Kuppermann N, Holmes JF, Dayan PS. , et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374 (9696): 1160-1170
• 25 Nielsen JW, Boomer L, Kurtovic K. , et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg 2015; 50 (01) 144-148
• 26 Callahan MJ, Anandalwar SP, MacDougall RD. , et al. Pediatric CT dose reduction for suspected appendicitis: a practice quality improvement project using artificial gaussian noise--part 2, clinical outcomes. Am J Roentgenol 2015; 204 (03) 636-644
• 27 Bachur RG, Hennelly K, Callahan MJ, Monuteaux MC. Advanced radiologic imaging for pediatric appendicitis, 2005-2009: trends and outcomes. J Pediatr 2012; 160 (06) 1034-1038
• 28 Philpott CM, Selvadurai D, Banerjee AR. Paediatric retropharyngeal abscess. J Laryngol Otol 2004; 118 (12) 919-926
• 29 Cabrera CE, Deutsch ES, Eppes S. , et al. Increased incidence of head and neck abscesses in children. Otolaryngol Head Neck Surg 2007; 136 (02) 176-181
• 30 Sichel JY, Dano I, Hocwald E, Biron A, Eliashar R. Nonsurgical management of parapharyngeal space infections: a prospective study. Laryngoscope 2002; 112 (05) 906-910
• 31 Craig FW, Schunk JE. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. Pediatrics 2003; 111 (6 Pt 1): 1394-1398
• 32 Broughton RA. Nonsurgical management of deep neck infections in children. Pediatr Infect Dis J 1992; 11 (01) 14-18
• 33 Lalakea Ml, Messner AH. Retropharyngeal abscess management in children: current practices. Otolaryngol Head Neck Surg 1999; 121 (04) 398-405
• 34 Kirse DJ, Roberson DW. Surgical management of retropharyngeal space infections in children. Laryngoscope 2001; 111 (08) 1413-1422
• 35 Bandarkar AN, Adeyiga AO, Fordham MT, Preciado D, Reilly BK. Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. Pediatr Radiol 2016; 46 (07) 1059-1067
• 36 Bolton M, Wang W, Hahn A, Ramilo O, Mejias A, Jaggi P. Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone. Pediatr Infect Dis J 2013; 32 (09) 1034-1036
• 37 Abdel-Haq N, Quezada M, Asmar BI. Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus . Pediatr Infect Dis J 2012; 31 (07) 696-699
• 38 Brown NK, Hulten KG, Mason EO, Kaplan SL. Staphylococcus aureus retropharyngeal abscess in children. Pediatr Infect Dis J 2015; 34 (04) 454-456
• 39 Grant MC, Guarisco JL. Association between computed tomographic scan and timing and treatment of peritonsillar abscess in children. JAMA Otolaryngol Head Neck Surg 2016; 142 (11) 1051-1055
• 40 Ghaffar FA, Wördemann M, McCracken Jr GH. Acute mastoiditis in children: a seventeen-year experience in Dallas, Texas. Pediatr Infect Dis J 2001; 20 (04) 376-380
• 41 Ghadersohi S, Young NM, Smith-Bronstein V, Hoff S, Billings KR. Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital. Laryngoscope 2017; 127 (10) 2321-2327
• 42 Marom T, Roth Y, Boaz M. , et al. Acute mastoiditis in children: necessity and timing of imaging. Pediatr Infect Dis J 2016; 35 (01) 30-34