BACKGROUND: Acute respiratory infections (ARI) are a common cause of inappropriate antibiotic prescription (ATB) in pediatrics. FebriDx® is a rapid diagnostic test that differentiates between viral and bacterial infections. The objective is to analyse the impact of FebriDx® on ATB prescription when managing febrile ARI.
METHODS: Prospective study carried out in patients aged 1-<18 years with febrile ARI in the emergency department. FebriDx® was performed and the impact on management was evaluated at follow-up.
RESULTS: A total of 216 patients were included. Clinical assessment and FebriDx® result coincided coincided in 174 (80.5%) cases. A modification of the initial therapeutic plan was made in 22 (52.4%) of the 42 discordant ones (10.2% of the overall patients). In pneumonia the impact was 34.5%; in all cases it involved not prescribing ATB.
CONCLUSIONS: FebriDx® could be a useful tool in the management of pediatric patients with febrile ARI to optimize ATB prescription.

To analyze the role played by the clinical pharmacist and its impact in antibiotic stewardship facing suspected allergy to beta-lactam antibiotics.
We performed 2 different independent bibliographic searches. A total of 35 articles were found, and the final number included in the study was 12. We analyzed the articles and collected variables of efficacy, safety, and applicability of evaluation tools applied to patients with suspected allergy to beta-lactams. Also, the variation in the consumption and prescription profile of alternative antibiotics was analyzed.
The selected studies analyzed questionnaires, allergy delabeling, intradermal tests, and oral challenge tests performed by pharmacists. Significant differences in the efficacy endpoint were found in 4 studies in favor of pharmaceutical intervention. In the study of Kwiatkowski et al., cefazolin use increased in surgical patients after pharmacist intervention (65% vs 28%; P < .01). In a quasi-experimental study, the mean defined daily dose of aztreonam and the mean days of therapy per 1000 patients/day decreased (21.23 vs 9.05, P <.01) and (8.79-4.24, P = .016), pre- and post-intervention, respectively, increasing antibiotic de-escalations (P = < .01). In another quasi-experimental study, the prescription of restricted use antibiotics decreased (42.5% vs 17.9%, P < .01)and the use of pre-surgical prophylactic antibiotics alternative to cefazolin (81.9% vs 55.9%, P < .01)in another study. Other study showed that the mean time per interview was 5.2 min per patient. No adverse events were reported in any study.
The pharmacist intervention in the evaluation of the patient with suspected allergy to beta-lactams is effective, safe, and feasible to implement on daily clinical practice. The standardization of protocols to clarify the history of allergies and development of evaluation tools represent simple screenings to perform delabeling or refer to the Immunoallergology service, improving penicilins use and reducing the need for second-line antibiotics. More studies are needed to standardize the desensitization tests made by pharmacists. However, despite these results, the involvement and leadership of the pharmacist in this area is limited and constitutes a future challenge for the profession.

To analyze the role played by the clinical pharmacist and its impact in antibiotic stewardship facing suspected allergy to beta-lactam antibiotics.
We performed two different independent bibliographic searches. A total of 35 articles were found, and the final number included in the study was 12. We analysed the articles and collected variables of efficacy, safety and applicability of evaluation tools applied to patients with suspected allergy to beta-lactams. Also, the variation in the consumption and prescription profile of alternative antibiotics was analyzed.
The selected studies analysed questionnaires, allergy delabeling, intradermal tests and oral challenge tests performed by pharmacists. Significant differences in the efficacy endpoint were found in 4 studies in favour of pharmaceutical intervention. In the study of Kwiatkowski et al, cefazolin use increased in surgical patients after pharmacist intervention (65 vs. 28%; p < 0.01). In a quasi-experimental study, the mean defined daily dose of aztreonam and the mean days of therapy per 1000 patients/day decreased (21.23 vs 9.05, p <0.01) and (8.79-4.24, p = 0.016), pre and post-intervention, respectively, increasing antibiotic de-escalations (p ≤ 0.01). In another quasi-experimental study, the prescription of restricted-use antibiotics decreased (42.5% vs. 17.9%, p < 0.01) and the use of pre-surgical prophylactic antibiotics alternative to cefazolin (81.9% vs 55.9%, p<0.01) in another study. Other study showed that the mean time per interview was 5.2 minutes per patient. No adverse events were reported in any study.
The pharmacist intervention in the evaluation of the patient with suspected allergy to beta-lactams is effective, safe and feasible to implement on daily clinical practice. The standardization of protocols to clarify the history of allergies and development of evaluation tools represent simple screenings to perform delabelling or refer to the Immunoallergology service, improving penicilins use and reducing the need for second line antibiotics. More studies are needed to standardize the desensitization tests made by pharmacists. However, despite these results, the involvement and leadership of the pharmacist in this area is limited and constitutes a future challenge for the profession.

OBJECTIVE: To detect the problems hospital emergency room staff have when prescribing and administering antibiotics.
METHODS: A 14-item questionnaire was designed to assess staff members\' knowledge of the importance of starting antibiotic treatment promptly, assigning appropriate dosing intervals, adjusting for renal function, and switching to oral therapy. Agreement with each item was expressed on a 5-point Likert scale. Items with a rate of appropriate response of less than 75% were targeted for specific attention.
RESULTS: Two hundred questionnaires were distributed to the staff and 150 were returned completed (response rate, 75%). The following items were targeted for attention based on rates of appropriate response of less than 75%: clear medical orders (65%), understanding the implication of early empirical antibiotic therapy on prognosis in serious infections (67%), estimation of the prevalence of renal insufficiency (42%), assumption that a creatinine serum level under < 1.6 mg/dL is safe (33%), use of glomerular filtration rate to adjust dose according to renal function (47%), and an understanding of switching from intravenous to oral treatment (60%).
CONCLUSIONS: This study revealed the difficulties medical and nursing staff have in prescribing and administering antibiotics in a hospital emergency department. The results can facilitate improvements in antibiotic therapy by pinpointing areas to target for specific training interventions or the design of electronic prescribing aids.
UNASSIGNED: Detectar las barreras con las que se encuentra el personal sanitario en la prescripción y administración de antibióticos en un servicio de urgencias hospitalario (SUH).
UNASSIGNED: Se diseñó una encuesta con 14 ítems para valorar el grado de conocimiento de la importancia de la precocidad en el inicio de tratamiento antibiótico, los intervalos de dosificación adecuados, el ajuste a la función renal y la terapia secuencial. Las respuestas a cada ítem fueron cualitativas con 5 categorías. Se consideró que los ítems que obtuvieron una respuesta correcta menor del 75% precisaban de una intervención específica.
UNASSIGNED: Se recogieron 150 encuestas cumplimentadas de las 200 repartidas entre el personal sanitario (tasa de respuesta del 75%). Los ítems con una respuesta correcta menor del 75% y que por tanto se consideró que requerían de una intervención específica fueron: la claridad en la órdenes médicas (65%), el conocimiento de la implicación del tratamiento antibiótico empírico precoz en el pronóstico de las infecciones graves (67%), la estimación de la prevalencia de la insuficiencia renal (42%), un valor de creatinina sérica inferior a 1,6 mg/dl considerado como seguro (33%), el filtrado glomerular como parámetro que se debe utilizar para ajustar la dosis a la función renal (47%) y el conocimiento de la terapia secuencial (60%).
UNASSIGNED: Este estudio permite conocer las dificultades con las que se encuentra el personal sanitario a la hora de prescribir y administrar antibióticos en un SUH y facilita el diseño de estrategias de mejora que incluyan desde formación específica a técnicas de prescripción electrónica.