jahidul hasan

Childhood diarrheal diseases are common with mild-to-severe mortality rate worldwide. Lower-middle-income countries (LMICs), including Bangladesh in South Asia, are still unable to save their under-5 lives due to diarrheal conditions.

The main aim of this study was to evaluate the duration of hospital stay and use of antibiotics in under-2 children with moderate diarrhea in Bangladesh. 

This study was done on hospitalized 6 months to 2 years old pediatric patients (n=212) with an uncontrolled moderate type of diarrhea in 3 districts of Bangladesh. Based on the history of diarrhea onset, 133 and 79 patients were allocated in the early hospitalization (EH) and delayed hospitalization (DH) groups, respectively.

To treat uncontrolled diarrhea at home, antibiotic therapy was initiated in 36.7% of patients in the DH group without any valid prescription, whereas only 7.5% of patients in the EH group received antibiotics (P<0.05). In the DH group, 67.1% of children received different antibiotic therapies for treating their diarrhea with or without other hospital-acquired infections during their extended hospital-stay period, resulting in antibiotic-associated adverse events (AAAEs) in 17.7% of the patients. At the same time, 21.1% of the patients in the EH group received antibiotics that caused AAAEs in 2.2% of them (P=0.001). The EH group, who received doctors’ consultations and hospitalized within 2 days of the onset of diarrhea, stayed in the hospital for a maximum of 4 days. It was less than half a time that of the children in the DH group (P<0.05) (stayed for a maximum of 10 days), who visited doctors and admitted to hospitals at a later stage of diarrheal-onset.

Early doctor visits and hospitalization of under-2 children with uncontrolled moderate diarrhea may reduce the severity of the disease and risk of severe acute malnutrition, minimize the use of antibiotics with minimum chance of occurrence of adverse drug events, and cause early discharge from hospital.

Urinary tract infection (UTI) can lead to adverse renal outcomes in the form of renal scarring and its consequences in children. Underlying congenital abnormalities of the kidney and urinary tract (CAKUT) play a crucial role in UTI recurrence and its outcome. 

This study was conducted to evaluate children aged 1 month to 18 years with bacteriuria retrospectively to assess recent trends of antimicrobial resistance, underlying structural abnormalities of the urinary tract, and severity of symptoms associated with it. Ultrasonography was done in children under 2 years with a history of recurrent UTI to exclude associated structural abnormalities of the urinary tract.

Of 255 studied children, 58% were female. Ultrasonography of the kidney and bladder was performed in 116 children, which revealed CAKUT in 38% (n=44). Children with CAKUT commonly presented with fever (36%) alone or in combination with other features. The most common pathogen was E coli (60%), which was very sensitive to intravenous aminoglycosides (95-100%) and carbapenems (96%) but had less sensitive to cephalosporins (43%). E coli showed higher resistance to oral cephalosporins and quinolones (62% and 54%, respectively). E coli had a high (93%) and Klebsiella spp had a low (63%) sensitivity to nitrofurantoin.

This study revealed that about one fifth of the children with bacteriuria had CAKUT. A higher resistance pattern was observed to commonly used oral antimicrobial agents, which eventually narrows down the choice of empirical antibiotic. Keywords: Child; Bacteriuria; Urinary Tract Infection; Urinary Tract Abnormalities.