READERS’ FORUM

Experience and guidelines

Dear Editor,I read the paper written by Dr Urkin et al.

(1), published in Acta Paediatrica in November2013. The authors describe an importantconcern with nonadherence to guidelines byphysicians. Congratulations for the study. Iwould like to extend this discussion to not onlyadherence to guideline for diagnosis andmanagement of respiratory infections, but alsofor the correct management of antibiotic thatwas prescribed. Recently, we conducted thisstudy in Brazil showing the differences in dosesof antibiotics used in children with respiratoryinfections.

This study evaluated 401 medical prescrip-tions for treating upper respiratory infections(URIs) in children (age 0–11) in a PublicHealth Clinic in S~ao Paulo State, Brazil. Using

the age and weight of the children and nationaland international guidelines (2,3), we calcu-lated the recommended daily dose of antibioticfor each child and compared it to thoseprescribed in the Public Health Clinic.

The diagnosed URIs were as follows: phar-yngitis (n = 353, 88.03%); otitis (n = 44,10.97%); and sinusitis (n = 4, 1.0%). Theantibiotics used in the treatments includedamoxicillin (AMOX), azithromycin (AZIT),trimethoprim/sulfamethoxazole (TMP/SMX)and cephalexin (CEPHA). The results areshown in Table 1.

The AMOX prescribed doses ranged from21.3 to 99.5 mg/kg/day, a difference of fivefold.Of the children treated with TMP/SMX, 92.3%(12 patients) received <80% of the recom-mended dose. None of the prescribed doses ofTMP/SMX met the recommended guidelines(2,3). The use of guidelines for standardised

antibiotic treatments can preserve antibioticsand reduce cost. In the 21th century, there isadequate scientific information to support therational prescription of antibiotics. Physiciansneed to use it.

References1. Urkin J, Allenbogen M, Friger M, Vinker S,Reuveni H, Elahayani A. Acute pharyngitis: lowadherence to guidelines highlights need forgreater flexibility in managing paediatric cases.Acta Paediatr 2013; 102: 1075–80.

2. Gilbert DN, Moellering RC Jr, Eliopoulos GM,Chambers HF, Saag MS, editors. The Sanfordguide to antimicrobial therapy 2013. 43rd ed.Sperryville, VA: Antimicrobial Therapy, Inc,2013.

3. National Therapeutic Formulary [Formul�arioTerapeutico Nacional]. In: DAF, editor. 2 edn.Bras�lia, 2010. Available from URL http://portal.saude.gov.br/portal/arquivos/pdf/FTN_2010.pdf.

DOI:10.1111/apa.12539

Fernando de S�a Del Fiol (fernando.fiol@prof.uniso.br), Nathalia Aparecida Gatto VieiraPharmacology Department, University of Sorocaba,Sorocaba, SP, Brazil

Correspondence: Prof Dr Fernando de S�a Del Fiol,Universidade de Sorocaba, Rodovia Raposo Tavares,Km 92.5, CEP: 18023-000, Sorocaba, Brazil.Tel: 55-15-99617-0589 |Fax: 55-15-21017074 |Email: fernando.fiol@prof.uniso.br

We certify that there is no conflict of interest withany financial organisation regarding the materialdiscussed in the manuscript.

Table 1 Used and recommended antibiotic doses for treatment of URIs in children

AMOX AZIT TMP/SMX CEPHA

Prescription frequency n (%) 302 (75.4) 8 (2.0) 13 (3.2) 78 (19.4)

Recommended dose (2,3) (mg/kg/day) 50.0 10.0 10.0 50.0

Prescribed doses (mean � SD) (mg/kg/day) 48.1 (8.2) 12.5 (1.9) 6.5 (0.9) 60.8 (10.0)

Lowest prescribed dose (mg/kg/day) 21.3 10.0 4.9 23.8

Highest prescribed dose (mg/kg/day) 99.5 15.4 8.6 82.9

Doses lower than 80% of recommended (%) 17.5 0.0 92.3 2.5

Doses lower than recommended (2,3) (%) 50.3 0.0 100.0 14.1

AMOX = Amoxicillin; AZIT = Azithromycin; TMP/SMX = Trimethoprim/sulfamethoxazole; CEPHA = Ceph-

alexin.

e138 ª2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, p. e138

Acta Pædiatrica ISSN 0803-5253