Scarce and limited epidemiological, clinical and microbiological data are available regarding pediatric respiratory tract infections in the Kingdom of Morocco, a middle-income country in Northwestern Africa. Data on antibiotic usage for such infections are also scarce. A good understanding of pre-admission and intra-hospital usage of antibiotics in children with respiratory infections linked with an adequate surveillance of the antibiotic susceptibility from circulating pathogens could help policy makers improve their recommendations on management of respiratory infections. We hereby present data on antibiotic usage prior and during admission and antibiotic susceptibility of major circulating respiratory pathogens in children under five years of age admitted to the H？pital d’Enfants de Rabat, Morocco, with a diagnosis of clinical severe pneumonia (using World Health Organization (WHO) standardized case definitions) during a period of 14 months (November 2010–December 2011), as part of a larger hospital-based surveillance study designed to understand the etiology and epidemiology of severe pneumonia cases among children.
References
[1]
Liu, L.; Johnson, H.L.; Cousens, S.; Perin, J.; Scott, S.; Lawn, J.E.; Rudan, I.; Campbell, H.; Cibulskis, R.; Li, M.; et al. Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet 2012, 379, 2151–2161, doi:10.1016/S0140-6736(12)60560-1.
[2]
Nair, H.; Simoes, E.A.; Rudan, I.; Gessner, B.D.; Azziz-Baumgartner, E.; Zhang, J.S.; Feikin, D.R.; Mackenzie, G.A.; Moisi, J.C.; Roca, A.; et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: A systematic analysis. Lancet 2013, 381, 1380–1390, doi:10.1016/S0140-6736(12)61901-1.
[3]
Kronman, M.P.; Hersh, A.L.; Feng, R.; Huang, Y.S.; Lee, G.E.; Shah, S.S. Ambulatory visit rates and antibiotic prescribing for children with pneumonia, 1994–2007. Pediatrics 2011, 127, 411–418, doi:10.1542/peds.2010-2008.
[4]
Earnshaw, S.; Monnet, D.L.; Duncan, B.; O’Toole, J.; Ekdahl, K.; Goossens, H. European Antibiotic Awareness Day, 2008—The first Europe-wide public information campaign on prudent antibiotic use: Methods and survey of activities in participating countries. Euro Surveill. 2009, 14, e19280.
[5]
Harnden, A.; Perera, R.; Brueggemann, A.B.; Mayon-White, R.; Crook, D.W.; Thomson, A.; Mant, D. Respiratory infections for which general practitioners consider prescribing an antibiotic: A prospective study. Arch. Dis. Child. 2007, 92, 594–597, doi:10.1136/adc.2007.116665.
[6]
Meropol, S.B.; Chen, Z.; Metlay, J.P. Reduced antibiotic prescribing for acute respiratory infections in adults and children. Br. J. Gen. Pract. 2009, 59, e321–e328, doi:10.3399/bjgp09X472610.
[7]
Nyquist, A.C.; Gonzales, R.; Steiner, J.F.; Sande, M.A. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA 1998, 279, 875–877, doi:10.1001/jama.279.11.875.
[8]
Centers for Disease Control and Prevention (CDC). Office-related antibiotic prescribing for persons aged ≤14 years—United States, 1993–1994 to 2007–2008. MMWR Morb. Mortal. Wkly. Rep. 2011, 60, 1153–1156.
[9]
Dowell, S.F.; Schwartz, B.; Phillips, W.R. Appropriate use of antibiotics for URIs in children: Part II. Cough, pharyngitis and the common cold. The Pediatric URI Consensus Team. Am. Fam. Physician 1998, 58, 1335–1342, 1345.
[10]
Dowell, S.F.; Marcy, S.M.; Phillips, W.R.; Gerber, M.A.; Schwartz, B. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998, 101, 163–165.
[11]
Grant, G.B.; Campbell, H.; Dowell, S.F.; Graham, S.M.; Klugman, K.P.; Mulholland, E.K.; Steinhoff, M.; Weber, M.W.; Qazi, S. Recommendations for treatment of childhood non-severe pneumonia. Lancet Infect. Dis 2009, 9, 185–196, doi:10.1016/S1473-3099(09)70044-1.
[12]
Soyka, L.F.; Robinson, D.S.; Lachant, N.; Monaco, J. The misuse of antibiotics for treatment of upper respiratory tract infections in children. Pediatrics 1975, 55, 552–556.
[13]
Chung, A.; Perera, R.; Brueggemann, A.B.; Elamin, A.E.; Harnden, A.; Mayon-White, R.; Smith, S.; Crook, D.W.; Mant, D. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: Prospective cohort study. Br. Med. J. 2007, 335, e429, doi:10.1136/bmj.39274.647465.BE.
[14]
Costelloe, C.; Metcalfe, C.; Lovering, A.; Mant, D.; Hay, A.D. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. Br. Med. J. 2010, 340, c2096, doi:10.1136/bmj.c2096.
[15]
Paluck, E.; Katzenstein, D.; Frankish, C.J.; Herbert, C.P.; Milner, R.; Speert, D.; Chambers, K. Prescribing practices and attitudes toward giving children antibiotics. Can. Fam. Physician 2001, 47, 521–527.
[16]
Rousounidis, A.; Papaevangelou, V.; Hadjipanayis, A.; Panagakou, S.; Theodoridou, M.; Syrogiannopoulos, G.; Hadjichristodoulou, C. Descriptive study on parents’ knowledge, attitudes and practices on antibiotic use and misuse in children with upper respiratory tract infections in Cyprus. Int. J. Environ. Res. Public Health 2011, 8, 3246–3262, doi:10.3390/ijerph8083246.
Watson, R.L.; Dowell, S.F.; Jayaraman, M.; Keyserling, H.; Kolczak, M.; Schwartz, B. Antimicrobial use for pediatric upper respiratory infections: Reported practice, actual practice, and parent beliefs. Pediatrics 1999, 104, 1251–1257, doi:10.1542/peds.104.6.1251.
[20]
Stivers, T. Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric encounters. Soc. Sci. Med. 2002, 54, 1111–1130, doi:10.1016/S0277-9536(01)00085-5.
[21]
Naimoli, J.F.; Rowe, A.K.; Lyaghfouri, A.; Larbi, R.; Lamrani, L.A. Effect of the integrated management of childhood illness strategy on health care quality in Morocco. Int. J. Qual. Health Care 2006, 18, 134–144.
[22]
Braikat, M.; Barkia, A.; El Mdaghri, N.; Rainey, J.J.; Cohen, A.L.; Teleb, N. Vaccination with Haemophilus influenzae type b conjugate vaccine reduces bacterial meningitis in Morocco. Vaccine 2012, 30, 2594–2599, doi:10.1016/j.vaccine.2012.01.041.
[23]
Ministry of Health. Enquête Nationale sur la Population et la Santé Familiale (ENPSF); Ministry of Health: Rabat, Morocco, 2011.
[24]
Benbachir, M.; Elmdaghri, N.; Belabbes, H.; Haddioui, G.; Benzaid, H.; Zaki, B. Eleven-year surveillance of antibiotic resistance in Streptococcus pneumoniae in Casablanca (Morocco). Microb. Drug Resist. 2012, 18, 157–160, doi:10.1089/mdr.2011.0130.
[25]
El Mdaghri, N.; Jilali, N.; Belabbes, H.; Jouhadi, Z.; Lahssoune, M.; Zaid, S. Epidemiological profile of invasive bacterial diseases in children in Casablanca, Morocco: Antimicrobial susceptibilities and serotype distribution. East. Mediterr. Health J. 2012, 18, 1097–1011.
[26]
Warda, K.; Oufdou, K.; Zahlane, K.; Bouskraoui, M. Antibiotic resistance and serotype distribution of nasopharyngeal isolates of Streptococcus pneumoniae from children in Marrakech region (Morocco). J. Infect. Public Health 2013, doi:10.1016/j.jiph.2013.06.003.
[27]
Santé en chiffres; Ministry of Health: Rabat, Morocco, 2011. Available online: http://srvweb.sante.gov.ma/Publications/Etudes_enquete/Documents/SC2011.pdf (accessed on 28 June 2013).
[28]
Mulholland, E.K.; Simoes, E.A.; Costales, M.O.; McGrath, E.J.; Manalac, E.M.; Gove, S. Standardized diagnosis of pneumonia in developing countries. Pediatr. Infect. Dis. J. 1992, 11, 77–81.
[29]
World Health Organization. Pocket Book for Hospital Care of Children: Guidelines for the Management of Common Illness with Limited Resources; WHO: Geneva, Switzerland, 2005.
[30]
Reed, C.; Madhi, S.A.; Klugman, K.P.; Kuwanda, L.; Ortiz, J.R.; Finelli, L.; Fry, A.M. Development of the Respiratory Index of Severity in Children (RISC) score among young children with respiratory infections in South Africa. PLoS One 2012, 7, e27793.
[31]
Members of the SFM Antibiogram Committee. Comite de l’Antibiogramme de la Societe Francaise de Microbiologie report 2003. Int. J. Antimicrob. Agents 2003, 21, 364–391, doi:10.1016/S0924-8579(03)00021-9.
[32]
Jroundi, I.; Mahraoui, C.; Benmessaoud, R.; Moraleda, C.; Tligui, H.; Seffar, M.; Kettani, S.C.; Benjelloun, B.E.; Chaacho, S.; Maaroufi, A.; et al. The epidemiology and aetiology of infections in children admitted with clinical severe pneumonia to a University hospital in Rabat, Morocco. Paediatr. Int. Child Health 2013. submitted for publication.
[33]
Grant, C.C.; Harnden, A.; Mant, D.; Emery, D.; Coster, G. Why do children hospitalised with pneumonia not receive antibiotics in primary care? Arch. Dis. Child. 2012, 97, 21–27, doi:10.1136/archdischild-2011-300604.
[34]
Senok, A.C.; Ismaeel, A.Y.; Al-Qashar, F.A.; Agab, W.A. Pattern of upper respiratory tract infections and physicians’ antibiotic prescribing practices in Bahrain. Med. Princ. Pract. 2009, 18, 170–174, doi:10.1159/000204345.
[35]
Risk, R.; Naismith, H.; Burnett, A.; Moore, S.E.; Cham, M.; Unger, S. Rational prescribing in paediatrics in a resource-limited setting. Arch. Dis. Child. 2013, 98, 503–509, doi:10.1136/archdischild-2012-302987.
[36]
Fossum, G.H.; Lindbaek, M.; Gjelstad, S.; Dalen, I.; Kvaerner, K.J. Are children carrying the burden of broad-spectrum antibiotics in general practice? Prescription pattern for paediatric outpatients with respiratory tract infections in Norway. Br. Med. J. Open 2013, doi:10.1136/bmjopen-2012-002285.
[37]
Bouskraoui, M. Guide Marocain des Anti-infectieux en Pédiatrie; Université Caddi Ayyad: Marrakech, Morocco, 2008.
[38]
Angoulvant, F.; Skurnik, D.; Bellanger, H.; Abdoul, H.; Bellettre, X.; Morin, L.; Aptecar, M.; Galli-Gibertini, G.; Bourdon, O.; Doit, C.; et al. Impact of implementing French antibiotic guidelines for acute respiratory-tract infections in a paediatric emergency department, 2005–2009. Eur. J. Clin. Microbiol. Infect. Dis. 2012, 31, 1295–1303, doi:10.1007/s10096-011-1442-4.
[39]
Valles, X.; Flannery, B.; Roca, A.; Mandomando, I.; Sigauque, B.; Sanz, S.; Schuchat, A.; Levine, M.; Soriano-Gabarro, M.; Alonso, P. Serotype distribution and antibiotic susceptibility of invasive and nasopharyngeal isolates of Streptococcus pneumoniae among children in rural Mozambique. Trop. Med. Int. Health 2006, 11, 358–366, doi:10.1111/j.1365-3156.2006.01565.x.
[40]
Farrell, D.J.; Felmingham, D.; Shackcloth, J.; Williams, L.; Maher, K.; Hope, R.; Livermore, D.M.; George, R.C.; Brick, G.; Martin, S.; et al. Non-susceptibility trends and serotype distributions among Streptococcus pneumoniae from community-acquired respiratory tract infections and from bacteraemias in the UK and Ireland, 1999 to 2007. J. Antimicrob. Chemoth. 2008, 62, ii87–ii95, doi:10.1093/jac/dkn355.
[41]
Cascone, C.; Mezzatesta, M.L.; Santagati, M.; Cafiso, V.; Nicoletti, G.; Stefani, S. Activity of telithromycin against multi-drug resistant Streptococcus pneumoniae and molecular characterization of macrolide and tetracycline resistance determinants. J. Chemother. 2005, 17, 502–508.
[42]
Pulcini, C.; Gyssens, I.C. How to educate prescribers in antimicrobial stewardship practices. Virulence 2013, 4, 192–202, doi:10.4161/viru.23706.
