Human Metapneumovirus in Infants
The aim of this study by Dr. John V. Williams and his associates at Vanderbilt University Medical Center was to determine the role of human metapneumovirus in lower respiratory tract illness in previously healthy infants and children.
The investigators tested nasal-wash specimens obtained from 2,009 infants and children who presented with acute respiratory tract illness between 1976 and 2001. There were 408 visits for lower respiratory tract illness by 321 children for which no cause was identified.
Of these 321 children, specimens from 248 were available. Of these 248 specimens, 49 (20%) contained human metapneumovirus RNA or viable virus (N. Engl. J. Med. 2004;350:443–50).
“Thus, 20% of all previously virus-negative lower respiratory tract illnesses were attributable to human metapneumovirus, which means that 12% of all lower respiratory tract illnesses in this cohort were most likely due to this virus,” Dr. Cantor said.
The virus was associated with bronchiolitis in 59% of cases, croup in 18%, pneumonia in 8%, and an exacerbation of asthma in 14%.
The findings suggest that human metapneumovirus “may be one of the primary causes of bronchiolitis,” Dr. Cantor said. “This was a great study.”
Antibiotic Tx For Urinary Tract Infection
The purpose of this metaanalysis by Dr. M. Michael and associates at the Children's Hospital at Westmead, New South Wales, Australia, was to compare the effectiveness of 2–4 days oral antibiotic therapy (short therapy) with 7–14 days (standard duration therapy) for children with urinary tract infections. The study population consisted of 652 children with lower tract UTI recruited from outpatient or emergency departments (Arch. Dis. Child. 2002;87:118–23).
The investigators found no significant differences in the frequency of positive urine cultures between the short and standard duration therapy for UTI in children 0–7 days after treatment and at 10 days to 15 months after treatment.
There also were no significant differences between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment or in recurrent UTI.
“We can probably get away with a shorter course of antibiotics [for this patient population],” Dr. Cantor said.
Interventions for Impetigo
A metaanalysis by S. Koning and colleagues was done to assess the effects of treatments for impetigo in 3,533 subjects who participated in 57 randomized, controlled trials of 20 different oral and 18 topical treatments for the condition (Cochrane Database Syst. Rev.[2]:CD003261.pub2, 2003).
Topical antibiotics showed better cure rates than placebo, and no topical antibiotic was superior.
Topical mupirocin was superior to oral erythromycin, but in most other comparisons, topical and oral antibiotics did not show significantly different cure rates, nor did most trials that compared oral antibiotics.
The reviewers concluded there is good evidence that topical mupirocin and topical fusidic acid are equally or more effective than oral treatment for people with limited disease.
It remains unclear whether oral antibiotics are superior to topical antibiotics for people with extensive impetigo.
Treating Pediatric Migraines
A prospective, randomized, double-blind study by Dr. David C. Brousseau and his colleagues at the Medical College of Wisconsin, Milwaukee, compared the efficacy of IV ketorolac and IV prochlorperazine in the treatment of pediatric migraines. The study population consisted of 62 children aged 5–18 years who presented with migraine headaches to the emergency departments at two children's hospitals (Ann. Emerg. Med. 2004;43:256–62).
Investigators defined successful treatment as a 50% or greater reduction in the McGrath Facial Affective Scale (nine faces pain scale) score at 60 minutes.
At 60 minutes, 16 (55.2%) of the 29 children who received ketorolac and 28 (84.8%) of the 33 children who received prochlorperazine were successfully treated. About 30% of children in each group had a recurrence of some headache symptoms.
“They recommend prochlorperazine,” Dr. Cantor said. “I do, too. Pick your drug and go with it.”
ED Analgesia for Fracture Pain
A study by Dr. Julie C. Brown and her colleagues compared the use of analgesics for fracture pain in adults and children based on an analysis of the emergency department component of the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey for 1997 through 2000 (Ann. Emerg. Med. 2003;42:197–205).
Of the 2,828 patients who had isolated closed fractures of the extremities or clavicle, 64% received any analgesic and 42% received a narcotic analgesic. Compared with adults, a lower proportion of children received any analgesic or a narcotic analgesic.
“This demonstrates that pain meds [for fracture pain] were not part of the armamentarium,” Dr. Cantor said. “Kids should get pain meds for fractures the minute they walk in the door, before they're processed.”