1.

Etiology and response to antibiotic therapy of community-acquired pneumonia in French

children

ABSTRACT

The aim of this study was to determine the etiologic agents associated with community-acquired
pneumonia in 104 French children ages 18 months to 13 years. Potential respiratory pathogens were
identified in 87 (85%) cases; these included respiratory syncytial virus in ten, other viruses in
20,Streptococcus pneumoniae in 14, andMycoplasma pneumoniae (diagnosed by serologic
procedures) in 43. Of 32 patients withMycoplasma pneumoniae infection who were initially treated
with beta-lactam antibiotics, 30 failed treatment. Recovery from mycoplasma infection occurred
rapidly in patients treated with macrolide antibiotics (which included spiramycin in 31 patients,
josamycin in 7, and erythromycin in 3); however, cough persisted in 12 patients for one month. The
high frequency ofMycoplasma pneumoniae infection in community-acquired pneumonia in children
over 18 months of age must be considered when selecting an antibiotic for initial therapy.

2. Epidemiology and Clinical Characteristics of Pediatric Drug-Resistant Tuberculosis in

Chongqing, China

ABSTRACT

To gain insight into the epidemiology of childhood drug resistant tuberculosis (DR-TB) in China
that has the second largest burden of TB and the largest number of multidrug resistant (MDR) TB cases
in the world, we performed the cross-sectional study to investigate drug resistance of four first-line
anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) using Mycobacterium tuberculosis
isolates from 196 culture-confirmed pediatric TB cases diagnosed in the Children’s Hospital of
Chongqing Medical University, China during 2008–2013. Univariate and multivariate logistic
regression analyses were performed to assess the associations between patient demographic and
clinical characteristics and DRand MDR-TB, respectively. Twenty-eight percent (56/196) of the study
patients exhibited resistance to at least one of the four first-line anti-TB drugs tested. MDR was found
in 4.6% (9/196) of the study patients. More than half (5/9, 55.6%) of the MDR cases were from a single
county of Chongqing. A significant association was found between being acid-fast bacilli-smear
negative and DR-TB (adjusted OR, 2.33; 95% CI, 1.13–4.80) and between having concurrent thoracic-
extrathoracic involvement and MDR-TB (adjusted OR, 9.49; 95% CI, 1.05–85.92), respectively. The
findings of this study indicate that the rate of DR is high among pediatric TB patients in Chongqing and
suggest an urgent need for studies to identify MDR transmission hotspots in Chongqing, thereby
contributing to the control DRand MDR-TB epidemics in China. The study also generates new insight
into the pathogenesis of DR and MDR M. tuberculosis strains and highlights the importance of studying
childhood TB to the goal of global TB control.
 3. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing
countries: pooled analysis of randomized controlled trials.

ABSTRACT

Background: Zinc deficiency is prevalent in children in developing countries. Supplemental zinc

provides therapeutic benefits in diarrhea.

Objective: We sought to measure the effect of supplemental zinc given with oral rehydration therapy
during recovery from acute or persistent diarrhea.

Design: We conducted pooled analyses including all available published and unpublished randomized
controlled trials of the effects of supplementary oral zinc in children aged < 5 y with acute or persistent
diarrhea. We used Cox survival regression analysis to evaluate the overall effect of zinc on
continuation of diarrhea and possible differential effects in subgroups divided by sex, age, weight-for-
height, and initial plasma zinc concentration. Dichotomous outcomes were analyzed by logistic
regression. To assess the effects of excluding studies without original data from the pooled analyses,
effect-size was estimated for all studies by using random-effects models.

Results: Zinc-supplemented children had a 15% lower probability of continuing diarrhea on a given
day (95% CI: 5%, 24%) in the acute-diarrhea trials and a 24% lower probability of continuing diarrhea
(95% CI: 9%, 37%) and a 42% lower rate of treatment failure or death (95% CI: 10%, 63%) in the
persistentdiarrhea trials. In none of the subgroup analyses were the 2 subgroups of each pair
significantly different from each other; however, in persistent diarrhea there tended to be a greater
effect in subjects aged < 12 mo, who were male, or who had wasting or lower baseline plasma zinc
concentrations.

Conclusion: Zinc supplementation reduces the duration and severity of acute and persistent diarrhea.

4. A COMPARISON OF BECLOMETHASONE, SALMETEROL, AND PLACEBO IN CHILDREN WITH

ASTHMA

ABSTRACT

Background ; An inhaled glucocorticoid is currently the medication of choice for long-term control of
persistent asthma in children. The role of long-acting b2-adrenergic–receptor agonists, such as
salmeterol, needs to be defined.

Methods : We conducted a randomized, double-blind, placebo-controlled, parallel-group, one-year

study of 241 children (mean [SD] age, 9.32.4 years) with clinically stable asthma and less than one
month of prior glucocorticoid use. We compared inhaled beclomethasone dipropionate (200 mg twice
daily) with salmeterol xinafoate (50 mg twice daily) and placebo (lactose). The primary outcome
measure, airway responsiveness (as assessed with a methacholine challenge), was evaluated before
treatment; after 3, 6, 9, and 12 months of treatment (12 and 36 hours after study medications had
been withheld); and 2 weeks after the end of treatment. Spirometry, symptoms, use of rescue
medication (200 mg of albuterol inhaled as needed), and adverse effects were also assessed.
 Results : During months 1 through 12 overall, beclomethasone was associated with significantly less
airway hyperresponsiveness than salmeterol (P0.003) or placebo
(P

0.001). This effect was lost two weeks after treatment had been stopped. As compared with placebo,
beclomethasone was associated with less variability between morning and evening in the peak
expiratory flow (P0.002), as was salmeterol (P0.02). Beclomethasone was also associated with a
reduced need for albuterol as rescue therapy
(P

0.001) and fewer withdrawals because of asthma exacerbations (P0.03), but salmeterol was not (P0.09
and P0.55, respectively). During months 1 through 12, linear growth was 3.96 cm in the children
receiving beclomethasone, as compared with 5.40 cm in the salmeterol group (P0.004) and 5.04 cm
in the placebo group (P0.018). Height was not measured after treatment ended.

Conclusions : Beclomethasone was effective in reducing airway hyperresponsiveness and in

controlling symptoms of asthma, but it was associated with decreased linear growth. Salmeterol was
not as effective as beclomethasone in reducing airway hyperresponsiveness or in controlling
symptoms; however, it was an effective bronchodilator and was not associated with rebound airway
hyperresponsiveness, masking of symptoms, or adverse effects.