Analysis of the use of medicines in the treatment of community-acquired pneumonia in children

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Currently, there is a tendency to constantly increase the prevalence of infections. According to who statistics, pneumonia is the cause of death in 15% of children under 5 years of age worldwide, 808,694 children died from pneumonia in 2017. In the Voronezh region, in 2019, 9158 cases of community-acquired pneumonia were registered with an incidence rate of 392.1 per 100 thousand population. At the same time, the incidence rate among children under 17 years of age was 1.9 times higher than the regional average, and amounted to 701.2 per 100 thousand.8 children under 17 years of age died of pneumonia in 2019. As a rule, this is due to the fact that the child's body has such anatomophysiological features as weak development of muscle and elastic tissue, an abundance of blood vessels throughout the respiratory tract, an "expiratory" structure of the chest, narrow and short bronchi, a greater reduction in the diameter of the trachea (by 1/3) during the respiratory cycle, and coughing. Pneumonia occurs in children of different ages and the frequency of occurrence is 10 cases per 1000. The first peak of morbidity is early age (reflects the critical period of development of the pulmonary system), up to 40 cases per 1000 patients. The second peak is high school and adolescence, which falls on endocrinological changes in the body. An urgent problem in Pediatrics is to reduce the mortality rate of patients diagnosed with pneumonia, thus, special attention is paid to the timely and reasonable administration of drugs that help improve the overall condition of patients.
Goal
Evaluation of the rationality of prescribing bronchodilators and corticosteroids in the treatment of acute community-acquired pneumonia of moderate severity in children in accordance with clinical recommendations.
Methods
1. research Design
The study design included a retrospective analysis of the medical histories of patients who were treated at the CSTO No. 2 in infectious departments in 2019 with a diagnosis of acute community-acquired pneumonia of moderate severity.
2. Eligibility criteria
The study included patients admitted to a medical institution by random sampling. The age of patients ranged from 1 year to 17 years, who were diagnosed. Inclusion criteria: presence or absence of bronchoobstructive syndrome in the diagnosis.
3. Modalities
The study was conducted at the Voronezh regional children's clinical hospital No. 2. Children with community-acquired pneumonia of moderate and severe severity from Voronezh with a concomitant diagnosis of SARS and districts of the Voronezh region are hospitalized in infectious departments.
4. The duration of the study
The analysis of medical records with the established diagnosis took place within 6 months.
5. Description of medical intervention
Information was collected and analyzed, including the established diagnosis, the dynamics of laboratory and instrumental indicators, the results of additional research methods (ECG, ultrasound, radiography), data on pharmacotherapy: prescribed drugs, doses and mode of use.
6. Main outcome of the study
Study of drug prescribing in the treatment of community-acquired pneumonia of moderate severity in children.
7. Additional outcomes of the study
Additional outcomes of the study have not been studied.
8. Analysis in subgroups
The analysis of drug prescriptions was carried out in the General group of children and in
subgroups of patients distributed by age and characterized by the presence or absence of bronchoobstructive syndrome.
9. Registration methods outcomes
We took into account patient examination data, results of additional examination methods, drug therapy, treatment effectiveness, and duration of hospitalization.
10. Statistical analysis
The sample size was not calculated beforehand. Statistical analysis was performed using Microsoft Excel programs.
Qualitative nominal and ordinal data are indicated with the frequency of occurrence, represented as an absolute value and relative (%). For comparison of quality indicators used the χ2 criterion, in cases of small sample sizes (when the number of observations in one cell of a fourfold table is <5) Fisher's exact test and the χ2 with the Yates correction for 2x2 tables.
Results
All patients were divided into two groups:
Group 1 children under 14 (83%) and group 2 children over 14 (17%)
It was found that among patients of the first age group, obstructive syndrome occurs only in 3 patients out of 100 studied, which, respectively, is 3.6%.
Among the patients of the second age group, the bronchial obstruction syndrome was detected in 13 patients (76.5%). There is a tendency to the presence of obstructive syndrome in predominantly male patients, which is 81.3%. Looking at this group by age, 81.3% of children were under the age of 14, and the remaining 18.7% were over the age of 14.
An important characteristic of the distribution of patients was the indication in the diagnosis of the presence of bronchoobstructive syndrome. The established diagnosis: acute community-acquired pneumonia of moderate severity without obstructive syndrome was in 84% of children, while the diagnosis: acute community – acquired pneumonia of moderate severity with obstructive syndrome was in 16% of children.
In the first study group, 15 patients out of 84 were prescribed drugs of the group of systemic glucocorticosteroids (Dexamethasone) and bronchodilators (aminophylline), which is unreasonable and deviates from the established clinical recommendations. In the second study group, all patients (100%) received medications based on clinical recommendations.
Considering patients diagnosed with pneumonia without obstructive syndrome in the context of rational drug administration, it was found that the number of days spent in hospital does not significantly differ between patients who were prescribed drugs of the group of glucocorticosteroids and bronchodilators, and those who were not prescribed these drugs. The duration of hospitalization of patients did not differ, and the average duration was 12 days. This proves the inexpediency of treatment with the above medications.
Discussion.
Community-acquired pneumonia currently continues to dominate the structure of child morbidity. Pharmacotherapeutic treatment, first of all, includes the appointment of antibacterial drugs, the action of which is directed at the pathogen, and patients with intoxication and severe pneumonia are shown to use hydration. Mucolytic therapy has a positive effect. Ambroxol increases the penetration of amoxicillin, cefuroxime, and erythromycin into the bronchial secret and lung tissue and stimulates the synthesis of surfactant. [3]. Perhaps the use of inhaled short-acting b2адреномиметика as monotherapy or in combination with holinoblokatora. [3]. In patients with confirmed bronchoobstructive syndrome, the use of glucocorticosteroids is recommended. This study analyzes the feasibility of prescribing groups of drugs, and identifies the drugs that are most commonly used in pediatric practice.
Conclusion.
The clinical picture of acute community-acquired pneumonia of moderate severity included the development of bronchial obstruction syndrome in only 16% of patients, but 91% of children received bronchodilators (ipratropia bromide/fenoterol) and inhaled glucocorticoids (budesonide), which does not fully comply with clinical recommendations. Conducting therapy in accordance with clinical recommendations and instructions for the use of drugs will contribute to effective and safe treatment of patients.

About the authors

Maria Pertseva

Author for correspondence.
Email: MariaPertceva@yandex.ru
ORCID iD: 0000-0001-8478-5244
SPIN-code: 1150-4668
Russian Federation

Elizabeth Nikolaevna Mironova

Email: elizabet_ti@mail.ru
ORCID iD: 0000-0002-1638-7356

Oksana Igorevna Ishkova

Email: oksishkova@gmail.com
ORCID iD: 0000-0002-7103-5900

References