Recent trends in practice patterns and impact of corticosteroid use on pediatric Mycoplasma pneumoniae-related respiratory infections

Okubo, Yusuke; Michihata, Nobuaki; Morisaki, Naho; Uda, Kazuhiro; Miyairi, Isao; Ogawa, Yuichi; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

doi:10.1016/j.resinv.2017.11.005

Cited by 27 publications

(22 citation statements)

References 21 publications

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“…The trend may have reflected a decrease in LOS and overall natural trends in pediatric inpatients in Japan. Indeed, similar decreasing patterns were observed in other pediatric disorders, such as immune thrombocytopenia, and respiratory infections such as Mycoplasma pneumoniae and influenza virus [17][18][19].…”

Section: Discussionsupporting

confidence: 72%

Recent practice patterns in diagnostic procedures anticonvulsants, and antibiotics for children hospitalized with febrile seizure

Okubo

Hayakawa

Nariai

et al. 2019

Seizure

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A B S T R A C TPurpose This study investigated clinical practice patterns for admissions due to FS at a national level.Method Discharge records were extracted for patients with FS aged < 6 years for the years 2010-16 using national inpatient database in Japan. We ascertained antiepileptic drug use, diagnostic procedures, healthcare costs, and length of hospital stays (LOS), using mixed effect linear or logistic regression models. We also investigated correlations between performance of lumbar puncture (LP), and use of head computed tomography (CT) and antibiotics.Results We identified a total of 94,452 eligible patients. Hospitalization costs and LOS in days decreased from 19,027 JPY and 4.6 days in 2010 to 18,753 JPY and 4.1 days in 2016. Phenytoin use decreased from 1.6% in 2010 to 0.5% in 2016, whereas fosphenytoin use increased from 0% in 2010 to 6.7% in 2016. Decreasing trends were observed in CT use (from 32.8% to 16.9%) and LP performance (16.9% to 13.5%). For the analyses at hospital levels, CT use and LP performance was positively correlated (r = 0.63). No correlations were observed between total and extremely broad-spectrum antibiotic use and CT use or LP performance in hospitals without cases of intensive care. Wide variations were observed across hospitals for performance of LP (0%-88%), use of CT (0%-84%) and antibiotics (10%-99%).Conclusion We provided novel insights into the current practice patterns for children with FS at individual levels, and delineated wide variations of LP, CT, and antibiotic use for the practices at hospital levels.

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Section: Discussionsupporting

confidence: 72%

Recent practice patterns in diagnostic procedures anticonvulsants, and antibiotics for children hospitalized with febrile seizure

Okubo

Hayakawa

Nariai

et al. 2019

Seizure

Self Cite

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“…The trend may have reflected a decrease in LOS and overall natural trends in pediatric inpatients in Japan. Similar decreasing patterns were observed in other common pediatric infectious and neurologic disorders including febrile seizure [26][27][28][29][30].…”

Section: Discussionsupporting

confidence: 76%

Recent treatment patterns and variations for pediatric acute encephalopathy in Japan

Hayakawa

Okubo

Nariai

et al. 2020

Brain and Development

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“…The use of FQs increased from 4.6% in 2010 to 22.6% in 2014, while macrolide use decreased from 62.8% in 2010 to 50.6% in 2014 in Japan. 58) The prevalence of MRMP in Japan decreased from 81.6% in 2012 to 43.6% in 2015, along with the decrease in macrolide use and the increase in FQ use. 8) As M. pneumoniae can easily become resistant to FQs through a single point mutation and FQs are broad-spectrum antibiotics, their use should be limited to children who have no other treatment options to prevent resistant strains.…”

Section: Treatmentmentioning

confidence: 99%

Current perspectives on atypical pneumonia in children

Shim

2020

Clin Exp Pediatr

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The major pathogens that cause atypical pneumonia are Myco plasma pneumoniae, Chlamydophila pneumoniae, and Legio nella pneumophila. Community-acquired pneumonia (CAP) caused by M. pneumoniae or C. pneumoniae is common in children and presents as a relatively mild and self-limiting disease. CAP due to L. pneumophila is very rare in children and progresses rapidly, with fatal outcomes if not treated early. M. pneumo niae, C. pneumoniae, and L. pneumophila have no cell walls; therefore, they do not respond to β-lactam antibiotics. Accordingly, macrolides, tetracyclines, and fluoroquinolones are the treatments of choice for atypical pneumonia. Macrolides are the first-line antibiotics used in children because of their low minimum inhibitory concentrations and high safety. The incidence of pneumonia caused by macrolide-resistant M. pneu moniae that harbors point mutations has been increasing since 2000, particularly in Korea, Japan, and China. The marked increase in macrolide-resistant M. pneumoniae pneumonia (MRMP) is partly attributed to the excessive use of macrolides. MRMP does not always lead to clinical nonresponsiveness to macrolides. Furthermore, severe complicated MRMP responds to corticosteroids without requiring a change in antibiotic. This implies that the hyper-inflammatory status of the host can induce clinically refractory pneumonia regardless of mutation. Empirical macrolide therapy in children with mild to moderate CAP, particularly during periods without M. pneumoniae epidemics, may not provide additional benefits over β-lactam monotherapy and can increase the risk of MRMP.

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Recent trends in practice patterns and impact of corticosteroid use on pediatric Mycoplasma pneumoniae-related respiratory infections

Cited by 27 publications

References 21 publications

Recent practice patterns in diagnostic procedures anticonvulsants, and antibiotics for children hospitalized with febrile seizure

Recent practice patterns in diagnostic procedures anticonvulsants, and antibiotics for children hospitalized with febrile seizure

Recent treatment patterns and variations for pediatric acute encephalopathy in Japan

Current perspectives on atypical pneumonia in children

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