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It is estimated that as many as 10 million unnecessary antibiotic prescriptions are written each year for children. Children are more likely to receive antibiotics for an upper respiratory infection in an urgent care center compared with the primary care office. However, no study has examined the antibiotic prescribing practices of the same physici...
Citations
... As upper respiratory tract infections are the most common illness for human beings, optimal diagnosis and treatment of a sore throat is required. Over-usage of antibiotics for acute pharyngitis has been reported in many countries [3,4]. Considering the seriousness of antimicrobial resistance Diseases 1. Acute pharyngitis Acute bacterial pharyngitis, mostly caused by GAS, is rather common in kindergarten-or young elementary school-age children [5,6]. ...
... It has been reported that more than 50% of sore throat patients visiting clinics were prescribed with antibiotics [3,4]. Considering that the proportion of GAS pharyngitis is less than 10% among sore throat patients, the overuse of antibiotics seems to be a serious problem. ...
Group A streptococci (GAS) cause diverse diseases ranging from mild to severe illnesses, and the global burden of GAS infections is enormous. Serological typing has been replaced by emm genotyping for the epidemiological study of GAS. Acute bacterial pharyngitis is a common illness, which requires either throat culture or rapid Ag test for diagnosis. Moreover, molecular point-of-care tests have been introduced owing to their higher sensitivity. Optimal diagnosis of bacterial pharyngitis is necessary for the adequate use of antibiotics. Although antimicrobial resistance (AMR) to erythromycin or clindamycin does not seem serious in Korea, it is very high in China, being reported at over 90%. Antibiotic surveillance and relevant education are necessary for primary clinical physicians and pediatricians. It is necessary to monitor AMR and develop a system for reporting the appearance of highly virulent diseases, such as necrotizing fasciitis or streptococcal toxic-shock syndrome, to the government authority.
... [6] The use of antibiotics in Korea is the third highest among Organization for Economic Cooperation and Development (OECD) countries; here, 21% of antibiotics are prescribed only for LRTIs. [7] In the US, 70,000 pediatric patients visit the emergency department for antibiotic-related adverse events annually, and 86.1% of these patients have allergic reactions. [8] In addition, previous studies have reported that antibiotics have no major benefits against LRTIs in patients [9] ; moreover, the overuse of antibiotics can lead to bacterial resistance. ...
Background:
The aim of this study is to assess the clinical evidence for or against Mahaenggamseok-tang (MHGT) as a treatment for lower respiratory tract infections (LRTIs) in pediatric patients.
Method:
This systematic review will include randomized clinical trials (RCTs) of MHGT, as a treatment for LRTIs, compared with other therapies such as placebo and western medicine. The search terms will be selected according to the medical subject heading. We will search the following databases for systematic reviews from 2000 to Feb 2020: 5 English databases (The Cochrane Database of Systematic reviews, MEDLINE, Excerpta Medica dataBASE, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature), 1 Chinese database, 5 Korean databases (Oriental Medicine Advanced Searching Integrated System, DataBase Periodical Information Academic (DBPIA), Research Information Service System, Korean Studies Information Service System, and National Digital Science Library), and 1 Japanese database (J-Stage). All RCTs of decoctions or alternate forms of MHGT will be included. We will search for all parallel or crossover RCTs without language restrictions. The methodological quality of the RCTs will be assessed using Cochrane risk of bias. Furthermore, the studies will be limited to those performed in children under 16 years of age.
Results and conclusions:
Our systematic review and meta-analysis will provide evidence for MHGT as a treatment for LRTI. The findings can help practitioners and patients recognize more effective and safer therapeutic methods.
Prospero registration number:
CRD42020165698.
... [9] Additionally, in South Korea, the use of antibiotics for URTI is substantial, though the prescription rate of antibiotics for URTI decreased from 73.33% in 2002 to 43,73% in 2014. [10] Inappropriate antibiotic or overuse for URTI is a contributor to antibiotic resistance, a public health threat. [11,12] Therefore, it is necessary to prevent the overuse or abuse of antibiotics for URTI. ...
Background:
Eunkyosan (EKS), also known as the Yinqiaosan formula, is widely applied for the common cold in East Asia. Many clinical trials have reported the efficacy and safety of the EKS formula for the treatment of the common cold.
Objectives:
This study aimed to assess the clinical evidence for and against the use of EKS formula as a treatment for the common cold.
Data sources:
The following databases were searched from inception to the present: MEDINLE, EMBASE, CENTRAL, AMED CINAHL for English articles; OASIS, the Korean Traditional Knowledge Portal, the Korean Studies Information Service System, KoreaMed, the Korean Medical Database and DBPIA); and 3 Chinese databases, including CNKI (i.e., the China Academic Journal, the China Doctoral Dissertations and Master's Theses Full-text Database, the China Proceedings of Conference Full-Text Database and the Century Journal Project), Wanfang and VIP. In addition, we searched a Japanese database and conduct non-electronic searches of conference proceedings.
Study eligibility criteria:
Prospective randomised controlled trials (RCTs) evaluating the effectiveness of EKS for the common cold were included in this review.
Participants:
All types of common colds were eligible for inclusion. Participants who had both the common cold and other conditions were excluded. There were no restrictions based on other factors, such as age, sex, or symptom severity.
Interventions:
Studies that evaluated any type of formulation (ie, decoction, tablet, pill, powder) of EKS were eligible for inclusion.
Study appraisal and synthesis methods:
Differences between intervention and control groups were assessed. Mean differences with 95% confidence intervals (CIs) were used to measure the effects of treatment for continuous data.
Methods and analysis:
Fourteen databases were searched in March 2018. We included RCTs examining EKS decoctions for any type of common cold. All RCTs of decoctions or modified decoctions were included. The methodological qualities of the RCTs were assessed using the Cochrane Collaboration tool for assessing risk of bias; confidence in the cumulative evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument.
Results:
A total of 315 potentially relevant studies were identified, and 4 RCTs met our inclusion criteria. Four RCTs tested the effects of EKS on the common cold, and all RCTs showed that EKS was superior regarding the treatment effect.
Limitations:
All RCTs were conducted in China, and the generalisation of these results to other countries might be limited. Most trials did not use internationally recognised reliability and validity outcome measurements. Moreover, the result of the response rate can be distorted by the practitioner. Future trials in compliance with international standards in the evaluation of treatment effects may resolve this issue.
Conclusion:
Our systemic review and meta-analysis provides suggestive evidence of the superiority of EKS over other therapies for treating the common cold. The level of evidence is low because of the high risk of bias.
Implications of key findings:
The results of this systematic review and meta-analysis provide suggestive evidence of the superiority of EKS alone or combined with conventional drugs.
Registration number:
CRD42018087694.
