The significance of fever in response to a bacterial infection has been investigated using the lizard Dipsosaurus dorsalis as an animal model. These lizards develop a fever of about 2 degrees C after injection with the bacterium Aeromonas hydrophila. To determine whether this elevation in body temperature increases the resistance of the host to this infection, as measured by survival, lizards were infected with the live bacteria and placed in a neutral (38 degrees C), low (34 degrees or 36 degrees C), or high (40 degrees or 42 degrees C) ambient temperature. An elevation in temperature following experimental bacterial infection results in a significant increase in host survival.

Source: MJ Kluger, DH Ringler, MR Anver: Fever and survival. in Science:  11 Apr 1975: Vol. 188, Issue 4184, pp. 166-168DOI: 10.1126/science.188.4184.166

(unfortunately not available for free)

Background: Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid‐acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continuous antiepileptic drugs.

Objectives: To evaluate primarily the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures; but also to evaluate any other drug intervention where there was a sound biological rationale for its use.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2016, Issue 7); MEDLINE (1966 to July 2016); Embase (1966 to July 2016); Database of Abstracts of Reviews of Effectiveness (DARE) (July 2016). We imposed no language restrictions. We also contacted researchers in the field to identify continuing or unpublished studies.

Selection criteria: Trials using randomised or quasi‐randomised participant allocation that compared the use of antiepileptic, antipyretic or other plausible agents with each other, placebo or no treatment.

Data collection and analysis: Two review authors (RN and MO) independently applied predefined criteria to select trials for inclusion and extracted the predefined relevant data, recording methods for randomisation, blinding and exclusions. For the 2016 update a third author (MC) checked all original inclusions, data analyses, and updated the search. Outcomes assessed were seizure recurrence at 6, 12, 18, 24, 36, and 48 months and at age 5 to 6 years in the intervention and non‐intervention groups, and adverse medication effects. We assessed the presence of publication bias using funnel plots.

Main results: We included 40 articles describing 30 randomised trials with 4256 randomised participants. We analysed 13 interventions of continuous or intermittent prophylaxis and their control treatments. Methodological quality was moderate to poor in most studies. We found no significant benefit for intermittent phenobarbitone, phenytoin, valproate, pyridoxine, ibuprofen or zinc sulfate versus placebo or no treatment; nor for diclofenac versus placebo followed by ibuprofen, acetaminophen or placebo; nor for continuous phenobarbitone versus diazepam, intermittent rectal diazepam versus intermittent valproate, or oral diazepam versus clobazam.

There was a significant reduction of recurrent febrile seizures with intermittent diazepam versus placebo or no treatment, with a risk ratio (RR) of  0.64 (95% confidence interval (CI) 0.48 to 0.85 at six months), RR of 0.69 (95% CI 0.56 to 0.84) at 12 months, RR 0.37 (95% CI 0.23 to 0.60) at 18 months, RR 0.73 (95% CI 0.56 to 0.95) at 24 months, RR 0.58 (95% CI 0.40 to 0.85) at 36 months, RR 0.36 (95% CI 0.15 to 0.89) at 48 months, with no benefit at 60 to 72 months. Phenobarbitone versus placebo or no treatment reduced seizures at 6, 12 and 24 months but not at 18 or 72 month follow‐up (RR 0.59 (95% CI 0.42 to 0.83) at 6 months; RR 0.54 (95% CI 0.42 to 0.70) at 12 months; and RR 0.69 (95% CI 0.53 to 0.89) at 24 months). Intermittent clobazam compared to placebo at six months resulted in a RR of 0.36 (95% CI 0.20 to 0.64), an effect found against an extremely high (83.3%) recurrence rate in the controls, which is a result that needs replication.

The recording of adverse effects was variable. Lower comprehension scores in phenobarbitone‐treated children were found in two studies. In general, adverse effects were recorded in up to 30% of children in the phenobarbitone‐treated group and in up to 36% in benzodiazepine‐treated groups. We found evidence of publication bias in the meta‐analyses of comparisons for phenobarbitone versus placebo (eight studies) at 12 months but not at six months (six studies); and valproate versus placebo (four studies) at 12 months, with too few studies to identify publication bias for the other comparisons.

Most of the reviewed antiepileptic drug trials are of a methodological quality graded as low or very low. Methods of randomisation and allocation concealment often do not meet current standards; and treatment versus no treatment is more commonly seen than treatment versus placebo, leading to obvious risks of bias. Trials of antipyretics and zinc were of higher quality.

Authors' conclusions: We found reduced recurrence rates for children with febrile seizures for intermittent diazepam and continuous phenobarbitone, with adverse effects in up to 30%. Apparent benefit for clobazam treatment in one trial needs to be replicated to be judged reliable. Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management and, most importantly, the benign nature of the phenomenon.

Source: Offringa M, Newton R, Cozijnsen MA, Nevitt SJ. Prophylactic drug management for febrile seizures in children. Cochrane Database Syst Rev. 2017;2(2):CD003031. Published 2017 Feb 22. doi:10.1002/14651858.CD003031.pub3 (frei zugänglich)

Objective: To compare the developmental and behavioral outcomes of children experiencing an initial vaccine-proximate (VP) febrile seizure (FS) to those having a non–VP-FS (NVP-FS) and controls who have not had a seizure.

Methods: In this prospective multicenter cohort study, children with their first FS before 30 months of age between May 2013 and April 2016 were recruited from 4 Australian pediatric hospitals and classified as having VP-FS or NVP-FS. Similar-aged children with no seizure history were recruited as controls. The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) was administered to participants with FS 12 to 24 months after their initial FS and to controls 12 to 42 months of age at the time of assessment. The primary outcome was the Bayley-III cognitive score. Children's preacademic skills were assessed with the Woodcock-Johnson Tests of Achievement, Third Edition, and their behavior and executive functioning were obtained from parent questionnaires.

Results: There was no significant difference in cognitive function between children with VP-FS (n = 62), those with NVP-FS (n = 70), and controls (n = 90) (F2,219 = 2.645, p = 0.07). There were no differences between the groups for all other measures and no increased risk of borderline/significant impairment or behavior in the clinical range in children with VP-FS compared to those with NVP-FS or controls.

Conclusion: VP-FS was not associated with an increased risk of developmental or behavioral problems in young children compared to children with NVP-FS or controls. Parents and providers should be reassured by the absence of adverse effects of VP-FS on the development of children.

Source: Lucy Deng, Nicholas Wood, Kristine Macartney, Michael Gold, Nigel Crawford, Jim Buttery, Peter Richmond, Belinda Barton. Developmental outcomes following vaccine-proximate febrile seizures in children. Neurology. 1. Jul 2020, DOI: 10.1212/WNL.0000000000009876

Aims and objectives. The purpose of this study was to assess the level of anxiety and uncertainty in Korean mothers of children with febrile convulsion and to indentify factors associated with maternal anxiety.

Background. In general, febrile convulsions are harmless to the child, but parents perceive the convulsion as frightening. Previous authors of a few studies suggested that providing information was helpful for parents’ knowledge, attitude and fear about a febrile convulsion.

Design. This was a descriptive, cross‐sectional survey.

Methods. The sample comprised 102 mothers whose children had been diagnosed with a febrile convulsion and admitted to paediatric wards in five general hospitals in South Korea. The researchers gave the questionnaires to nursing departments for distribution and collection by paediatric nurses. To test differences in anxiety and uncertainty by participants’ characteristics, t‐tests and anova were conducted. Linear regression was used to identify factors associated with maternal state anxiety. Statistical significance level was set at 0·05.

Results. A multiple linear regression of maternal anxiety showed that four statistically significant predictors explained 56% of the total variations of maternal anxiety. The significant predictors were uncertainty, frequency of febrile convulsion, income and information about febrile convulsion. Among the significant variables, uncertainty was the dominant contributing factor (p < 0·001).

Conclusions. Anxiety in mothers of children with febrile convulsion was especially related to uncertainty, so health care providers can reduce anxiety through decreasing uncertainty.

Source: Hyeon Ok Ju, Beverly J McElmurry, Chang Gi Park, Linda McCreary, Minju Kim and Eun Joo Kim. 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 1490–1497
doi: 10.1111/j.1365-2702.2010.03496.x

Background: Febrile seizures are the most common neurologic disorder in childhood. Physicians should be familiar with the proper evaluation and management of this common condition.

Objective: To provide an update on the current understanding, evaluation, and management of febrile seizures.

Methods: A PubMed search was completed in Clinical Queries using the key terms ‘febrile convulsions’ and ‘febrile seizures’. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews.

Results: Febrile seizures, with a peak incidence between 12 and 18 months of age, likely result from a vulnerability of the developing central nervous system to the effects of fever, in combination with an underlying genetic predisposition and environmental factors. The majority of febrile seizures occur within 24 hours of the onset of the fever. Febrile seizures can be simple or complex. Clinical judgment based on variable presentations must direct the diagnostic studies which are usually not necessary in the majority of cases. A lumbar puncture should be considered in children younger than 12 months of age or with suspected meningitis. Children with complex febrile seizures are at risk of subsequent epilepsy. Approximately 30–40% of children with a febrile seizure will have a recurrence during early childhood. The prognosis is favorable as the condition is usually benign and self-limiting. Intervention to stop the seizure often is unnecessary.

Conclusion: Continuous preventative antiepileptic therapy for the prevention of recurrent febrile seizures is not recommended. The use of intermittent anticonvulsant therapy is not routinely indicated. Antipyretics have no role in the prevention of febrile seizures.

Source:Leung AK, Hon KL, Leung TN. Febrile seizures: an overview. Drugs Context. 2018 Jul 16;7:212536. doi: 10.7573/dic.212536. PMID: 30038660; PMCID: PMC6052913.

Although national and international guidelines on the management of childhood and adolescent fever are available, some inadequate practices persist, both from parents and healthcare professionals. The main goal of bringing children’s temperature back to normal can lead to the choice of inappropriate drugs or non-necessary combination/alternation of antipyretic treatments. This behavior has been described in the last 35 years with the concept of fever-phobia, caused also by the dissemination of unscientific information and social media. It is therefore increasingly important that pediatricians continue to provide adequate information to parents in order to assess the onset of signs of a possible condition of the child’s discomfort rather than focusing only on temperature. In fact, there is no clear and unambiguous definition of discomfort in literature. Clarifying the extent of the feverish child’s discomfort and the tools that could be used to evaluate it would therefore help recommend that antipyretic treatment is appropriate only if fever is associated with discomfort.

Source: Mattia Doria, Domenico Careddu, Flavia Ceschin, Maria Libranti, Monica Pierattelli, Valentina Perelli, Claudia Laterza, Annarita Chieti, Elena Chiappini: Understanding Discomfort in Order to Appropriately Treat Fever. Int J Environ Res Public Health. 2019;16(22):4487. Published 2019 Nov 14. doi:10.3390/ijerph16224487 (komplett verfügbar)

Many parents experience “fever phobia”, based on misconceptions regarding the repercussions of fever in their children. The aim of this paper was to explore the conceptualizations of parents who are health professionals and parents without health qualifications on childhood fever. This qualitative study was based on grounded theory using a triangulated sample (theoretical sampling and snowball sampling) of parents of children aged 0 to 12 years old who received care for fever in the Emergency Primary Care Services two in Spanish municipalities. Data collection was based on focus groups segmented by gender, place of residence and education. Data analysis followed the constant comparative method and involved a coding process. Results show that independently of the parents’ place of residence or education, their perceptions of fever were somewhat ambivalent, beneficial at times, but also harmful. Parents acknowledged feelings of concern, fear, being overwhelmed, freezing up and relief once the fever was controlled. Health professional parents considered they had an extra responsibility for caring. Finally, parents without health education demanded more information from professionals. These results provide key information for the design of interventions directed at the management of fever in children.

Source: Villarejo-Rodríguez MG, Rodríguez-Martín B. A Qualitative Study of Parents' Conceptualizations on Fever in Children Aged 0 to 12 Years. Int J Environ Res Public Health. 2019;16(16):2959. Published 2019 Aug 16. doi:10.3390/ijerph16162959 (komplett verfügbar)

Objectives. Fever is one of the most common reasons that parents seek medical attention for their children. Parental concerns arise in part because of the belief that fever is a disease rather than a symptom or sign of illness. Twenty years ago, Barton Schmitt, MD, found that parents had numerous misconceptions about fever. These unrealistic concerns were termed “fever phobia.” More recent concerns for occult bacteremia in febrile children have led to more aggressive laboratory testing and treatment. Our objectives for this study were to explore current parental attitudes toward fever, to compare these attitudes with those described by Schmitt in 1980, and to determine whether recent, more aggressive laboratory testing and presumptive treatment for occult bacteremia is associated with increased parental concern regarding fever.

Methods. Between June and September 1999, a single research assistant administered a cross-sectional 29-item questionnaire to caregivers whose children were enrolled in 2 urban hospital-based pediatric clinics in Baltimore, Maryland. The questionnaire was administered before either health maintenance or acute care visits at both sites. Portions of the questionnaire were modeled after Schmitt's and elicited information about definition of fever, concerns about fever, and fever management. Additional information included home fever reduction techniques, frequency of temperature monitoring, and parental recall of past laboratory workup and treatment that these children had received during health care visits for fever.

Results. A total of 340 caregivers were interviewed. Fifty-six percent of caregivers were very worried about the potential harm of fever in their children, 44% considered a temperature of 38.9°C (102°F) to be a “high” fever, and 7% thought that a temperature could rise to ≥43.4°C (≥110°F) if left untreated. Ninety-one percent of caregivers believed that a fever could cause harmful effects; 21% listed brain damage, and 14% listed death. Strikingly, 52% of caregivers said that they would check their child's temperature ≤1 hour when their child had a fever, 25% gave antipyretics for temperatures <37.8°C (<100°F), and 85% would awaken their child to give antipyretics. Fourteen percent of caregivers gave acetaminophen, and 44% gave ibuprofen at too frequent dosing intervals. Of the 73% of caregivers who said that they sponged their child to treat a fever, 24% sponged at temperatures ≤37.8°C (≤100°F); 18% used alcohol. Forty-six percent of caregivers listed doctors as their primary resource for information about fever. Caregivers who stated that they were very worried about fever were more likely in the past to have had a child who was evaluated for a fever, to have had blood work performed on their child during a febrile illness, and to have perceived their doctors to be very worried about fever. Compared with 20 years ago, more caregivers listed seizure as a potential harm of fever, woke their children and checked temperatures more often during febrile illnesses, and gave antipyretics or initiated sponging more frequently for possible normal temperatures.

Conclusions. Fever phobia persists. Pediatric health care providers have a unique opportunity to make an impact on parental understanding of fever and its role in illness. Future studies are needed to evaluate educational interventions and to identify the types of medical care practices that foster fever phobia.fever, fever phobia, child, children, antipyretics, sponging, health care practices.

Source: Michael Crocetti, Nooshi Moghbeli and Janet Serwint. Fever Phobia Revisited: Have Parental Misconceptions About Fever Changed in 20 Years? Pediatrics June 2001, 107 (6) 1241-1246; DOI: https://doi.org/10.1542/peds.107.6.1241 

Parents can transmit their anxiety to their child, and just as children can pick up on parental anxiety, they can also respond to a parent's ability to stay calm in stressful situations. Therefore, when treating children, it is important to address parental anxiety and to improve their understanding of their child's ailment. Parental understanding and management of both pain and fever – common occurrences in childhood – is of utmost importance, not just in terms of children's health and welfare, but also in terms of reducing the economic burden of unnecessary visits to paediatric emergency departments. Allaying parental anxiety reduces the child's anxiety and creates a positive feedback loop, which ultimately affects both the child and parent.

Source:

Clinch, J., Dale, S. Managing childhood fever and pain – the comfort loop. Child Adolesc Psychiatry Ment Health 1, 7 (2007).

https://doi.org/10.1186/1753-2000-1-7

Hintergrund: Das maligne Melanom ist ein Krebs, der von Pigmentzellen in der Haut, den so genannten Melanozyten, ausgeht. Das Langzeitüberleben eines Patienten mit fortgeschrittenem Melanom ist selten.

Fall: Wir stellen einen einzigartigen Fall einer Patientin vor, die seit mehr als 13 Jahren an einem malignen Melanom leidet. Die Krankheit schritt rasch voran, und 19 Monate nach der Diagnose wurde das Melanomen der Patientin als eines im Stadium IV klassifiziert. Nach mehreren Jahren hatte die Patientin mehrere Fieberschübe, die nicht absichtlich medikamentös behandelt wurden. Nach jedem Fieberschub beobachtete die Patientin das Verschwinden von Tumoren, was durch eine medizinische Untersuchung bestätigt wurde. Interessanterweise hat die Patientin seit ihrer Erstdiagnose die meisten der vorgeschlagenen medizinischen Behandlungen abgelehnt. Folglich wurden nur einige der chirurgischen Eingriffe durchgeführt. Gegenwärtig leidet die Patientin trotz der anfänglich schlechten Prognose nur an Symptomen, die das Ergebnis einer chirurgischen Resektion von Hirnmetastasen sind. Die meisten ihrer bösartigen Tumore sind entweder verschwunden oder haben sich ohne weiteres Wachstum stabilisiert.

Schlussfolgerungen: Das einsetzende Fieber hat den typischen und ungünstigen Verlauf des Melanoms verändert und eine Remission oder zumindest eine Stabilisierung bewirkt. Diese Beobachtung legt, in Übereinstimmung mit anderen Beobachtungen auf diesem Gebiet, nahe, dass Fieber bei Krebspatienten nicht sofort behandelt werden sollte, sondern sich unter ärztlicher Aufsicht entwickeln kann.

Quelle: Wrotek S, Brycht Ł, Wrotek W, Kozak W. Fever as a factor contributing to long-term survival in a patient with metastatic melanoma: A case report. Complement Ther Med. 2018;38:7-10. doi:10.1016/j.ctim.2018.03.009

Fieber bei einem Kind ist eines der häufigsten klinischen Symptome, die von Kinderärzten und anderen Leistungserbringern des Gesundheitswesens behandelt werden, und ein häufiger Grund zur Sorge der Eltern. Viele Eltern verabreichen Antipyretika auch bei minimalem oder gar keinem Fieber, weil sie besorgt sind und meinen, dass das Kind eine "normale" Temperatur halten muss.

Fieber ist jedoch nicht die Grunderkrankung, sondern ein physiologischer Mechanismus, der sich positiv auf die Infektionsbekämpfung auswirkt. Es gibt keine Hinweise darauf, dass Fieber selbst den Krankheitsverlauf verschlechtert oder langfristige neurologische Komplikationen verursacht. Daher sollte das primäre Ziel der Behandlung des fiebrigen Kindes die Verbesserung des allgemeinen Wohlbefindens sein, anstatt sich auf die Normalisierung der Körpertemperatur zu konzentrieren.

Bei der Beratung der Eltern oder Betreuer eines fiebrigen Kindes sollten das allgemeine Wohlbefinden des Kindes, die Bedeutung der Überwachung von Aktivitäten, die Beobachtung auf Anzeichen einer schweren Erkrankung, die Förderung einer angemessenen Flüssigkeitsaufnahme und die sichere Lagerung von Antipyretika betont werden.

Aktuelle Erkenntnisse deuten darauf hin, dass es keinen wesentlichen Unterschied in der Sicherheit und Wirksamkeit zwischen Paracetamol und Ibuprofen bei der Versorgung eines allgemein gesunden Kindes mit Fieber gibt. Es gibt Hinweise darauf, dass die Kombination dieser beiden Produkte wirksamer ist als die Anwendung eines einzelnen Mittels allein; es gibt jedoch Bedenken, dass eine kombinierte Behandlung komplizierter sein und zur unsicheren Anwendung dieser Medikamente beitragen könnte. Kinderärzte sollten auch die Patientensicherheit fördern, indem sie sich für vereinfachte Formulierungen, Dosierungsanweisungen und Dosierungsgeräte einsetzen.

Quelle: Janice E. Sullivan, Henry C. Farrar, the Section on Clinical Pharmacology and Therapeutics and Committee on Drugs: Fever and Antipyretic Use in Children. Pediatrics. March 2011, 127 (3) 580-587; DOI: https://doi.org/10.1542/peds.2010-3852

Zielsetzungen: Unser Ziel war die Entwicklung und Erprobung eines Instrumentes zur Einbeziehung von Eltern fiebriger Säuglinge im Alter ≤60 Tage, die in der Notaufnahme (ED) untersucht wurden. Das Instrument wurde entwickelt, um die Kommunikation für alle Eltern zu verbessern und die gemeinsame Entscheidungsfindung (SDM) zu unterstützen, ob eine Lumbalpunktion (LP) für Kleinkinder im Alter von 29 bis 60 Tagen durchgeführt werden soll. 

Methoden: Wir führten einen mehrphasigen Entwicklungs- und Testprozess durch:

1) individuelle, halbstrukturierte Interviews mit Eltern und Klinikern (pädiatrische und allgemeine Notfallmediziner (EM-Ärzte) und pädiatrische EM-Krankenschwestern), um ihre Präferenzen für ein Kommunikations- und SDM-Tool zu erfahren

2) Entwurf eines "Storyboards" des Tools mit dem Testen des Designeindrucks

3) Entwicklung eines Software-Anwendungs- (d.h. App-) Prototyps, genannt e-Care

4) Usability-Tests von e-Care unter Verwendung qualitativer Beurteilung und der System-Usability-Skala (SUS). 

Ergebnisse: Wir befragten 27 Eltern und 23 Kliniker. Die Interviews ergaben mehrere Themen:

• Ein Kommunikationsmittel sollte die verbale Kommunikation ergänzen, aber nicht ersetzen
• Ein webbasiertes Format wurde bevorzugt
• Informationen über Infektionen und Tests, einschließlich der Begründung für spezifische Tests, wären wertvoll
• Wir entwickelten dann getrennte Versionen von e-Care für Kleinkinder ≤28 Tage und 29 bis 60 Tage im Alter von 29 bis 60 Tagen, sowohl in Englisch als auch in Spanisch. Die e-Care-App umfasst 4 Abschnitte:

1) Homepage

2) warum die Tests durchgeführt werden

3) welche Tests durchgeführt werden

4) was nach den Tests geschieht, einschließlich einer Tabelle für Eltern von Kleinkindern im Alter von 29 bis 60 Tagen zum Vergleich der Risiken/Nutzen von LP als Vorbereitung für ein SDM-Gespräch.

Eltern und Kliniker berichteten, dass e-Care verständlich und hilfreich sei. Der durchschnittliche SUS-Score betrug 90,3 (95% Konfidenzintervall: 84-96,6), was einer "ausgezeichneten" Benutzerfreundlichkeit entspricht. 

Schlussfolgerungen: Die e-Care App ist ein benutzerfreundliches und verständliches Hilfsmittel zur Unterstützung der Kommunikation und SDM mit Eltern fieberhafter Säuglinge ≤60 Tage in der ED. 

Quelle: Aronson PL, Politi MC, Schaeffer P, et al. Development of an App to Facilitate Communication and Shared Decision-Making with Parents of Febrile Infants ≤60 Days Old [published online ahead of print, 2020 Jul 9]. Acad Emerg Med. 2020; doi:10.1111/acem.14082

Hintergrund: Ziel der vorliegenden Studie war es, die Prävalenz von patienten- und arztbezogenen Variablen abzuschätzen, die mit Antibiotikaverordnungen bei Patienten mit der Diagnose akuter Infektionen der unteren und oberen Atemwege (ALURTI), die in Allgemeinpraxen (GP) und Kinderarztpraxen behandelt werden, in Deutschland assoziiert sind.

Methoden: Die Analyse umfasste 1.140.095 erwachsene Personen in 1237 Allgemeinarztpraxen und 309.059 Kinder und Jugendliche in 236 pädiatrischen Praxen aus der Disease Analyzer Datenbank (IQVIA), die zwischen dem 1. Januar 2015 und dem 31. März 2019 mindestens eine Diagnose einer ALURTI erhalten hatten. Wir schätzten die Assoziation zwischen 35 vordefinierten Variablen und der Verschreibung von Antibiotika mithilfe von multivariaten logistischen Regressionsmodellen, getrennt für allgemeine und pädiatrische Praxen. Die Variablen beinhalteten den Anteil (in Prozent) von Antibiotika oder Phytopharmaka auf allen Verordnungen pro Praxis, als Indikator für die Verordnungspräferenz des Arztes.

Ergebnisse: Die Prävalenz der Antibiotika-Verschreibungen war bei Patienten, die in hausärztlichen Praxen behandelt wurden, höher (31,2 %) als in kinderärztlichen Praxen (9,1 %). In hausärztlichen Praxen zeigte sich die stärkste Assoziation mit der Antibiotika-Verordnungspräferenz, gefolgt von spezifischen Diagnosen (akute Bronchitis, Sinusitis, Pharyngitis, Laryngitis und Tracheitis) und einem höheren Patientenalter. In pädiatrischen Praxen waren akute Sinusitis und Bronchitis die Variablen mit der stärksten Assoziation, gefolgt von der Praxispräferenz für die Verschreibung von Antibiotika. Die stärkste Assoziation mit der Nicht-Verschreibung von Antibiotika war die Praxispräferenz für Phytopharmaka und die spezifische Diagnose einer viralen Infektion.

Schlussfolgerung: Diese Studie zeigt eine hohe Prävalenz der Verschreibung von Antibiotika für Patienten mit ALURTI in der Primärversorgung, insbesondere bei erwachsenen Patienten; arztbezogene Faktoren spielen eine wichtige Rolle, die bei Interventionen zur Reduzierung einer potenziell unangemessenen Antibiotikaverschreibung berücksichtigt werden sollten.

Quelle: Kern WV, Kostev K. Prevalence of and Factors Associated with Antibiotic Prescriptions in Patients with Acute Lower and Upper Respiratory Tract Infections—A Case-Control Study. Antibiotics. 2021; 10(4):455. doi.org/10.3390/antibiotics10040455 DOI: https://doi.org/10.3390/antibiotics10040455

Zielsetzung: Die akute Tonsillopharyngitis (ATP) ist eine häufige, saisonale Infektion vorwiegend viralen Ursprungs. Das Management zielt darauf ab, den Krankheitsverlauf zu verkürzen und das Wohlbefinden des Patienten wiederherzustellen. Wir haben eine Meta-Analyse durchgeführt, um zu untersuchen, ob die Behandlung mit dem Pelargonium sidoides-Extrakt EPs 7630 den Gebrauch von fiebersenkenden Medikamenten (z.B. Paracetamol) bei Kindern mit ATP reduziert.

Methoden: Es wurden Studien aus klinischen Studienregistern und der medizinischen Literatur identifiziert. In Frage kamen randomisierte, placebokontrollierte, klinische Studien, die EPs 7630 bei Kindern mit ATP untersuchten und die gleichzeitige Verabreichung von Paracetamol berichteten. Basierend auf den Rohdaten der in Frage kommenden Studien analysierten wir den kumulativen Paracetamolverbrauch sowie die Fähigkeit zum Schulbesuch am Ende der Behandlung. Drei Studien mit insgesamt 345 Kindern im Alter von 6 bis 10 Jahren, die an einer nicht-β-hämolytischen Streptokokken-ATP litten, wurden identifiziert und waren teilnahmeberechtigt. Den Kindern wurde EPs 7630 oder Placebo für 6 Tage verabreicht.

Ergebnisse: Im Vergleich zu Placebo reduzierte EPs 7630 die kumulative Paracetamol-Dosis um durchschnittlich 449 mg (95% Konfidenzintervall [KI]: 252-646 mg; p < 0,001). Insgesamt waren 19,1 % (EPs 7630) bzw. 71,5 % (Placebo) der Kinder am Ende der Behandlung immer noch nicht in der Lage, die Schule zu besuchen (Risikoverhältnis = 0,28; 95 % CI: 0,16-0,48; p < 0,001).

Schlussfolgerungen: Unsere Meta-Analyse zeigt, dass EPs 7630 den Einsatz von antipyretischer Komedikation reduziert und die Genesung beschleunigt.

Quelle: Seifert G, Funk P, Reineke T, Lehmacher W. Influence of EPs 7630 on Antipyretic Comedication and Recovery from Acute Tonsillopharyngitis in Children: A Meta-analysis of Randomized, Placebo-Controlled, Clinical Trials. J Pediatr Infect Dis 2021; 16(03): 122-8. DOI: 10.1055/s-0040-1722205