Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Miranda Hester

The Infectious Disease Society of America held a webcast on the current available treatment options for COVID-19 on the morning of November 23, 2020. During the week of Thanksgiving, as many continue to plan to travel or to host dinners on Thursday with many guests, the priority guidance from the participants was to continue with the safety measures that have helped people remain safe since the pandemic’s start in the United States: social distance, wash hands, use a mask, and reduce exposure to others.

The discussion on treatment began with discussing monoclonal antibodies, which have become a hot topic in COVID-19 treatment following the emergency use authorization from the US Food and Drug Administration for casirivimab and imdevimab over the weekend. Adarsh Bhimraj, MD, FIDSA, associate staff physician in the Department of Infectious Diseases at the Cleveland Clinic, in Ohio, and Rajesh T. Gandhi, MD, FIDSA, professor of medicine at Harvard Medical School in Boston, Massachusetts, both highlighted that the data for the efficacy of monoclonal antibodies are still in the early days of study, but the information coming in from the early studies appears to be positive. Gandhi also stressed that as of right now, only dexamethasone has been shown to improve survival.

Articles

Infectious Disease Society of America offered a look at the current treatment options for COVID-19 and stressed the need to maintain precautions to keep people safe.

Infectious Disease Society of America Webcast Discusses Available COVID-19 Treatments

When a child is in pain or has a fever, most parents will turn to either ibuprofen or acetaminophen to bring relief. A 

 looked at the analgesic and antipyretic qualities of both as well as the safety profiles.

The researchers ran a systematic search in MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, as well as the Australian New Zealand Clinical Trials Registry and ClinicalTrials.gov. Any study that looked at children aged younger than 2 years and was comparing acetaminophen to ibuprofen, and reporting antipyretic, analgesic, and/or safety outcomes were considered. Two researchers independently extracted the data and assessed the quality.

There were 19 studies included in the meta-analysis and the studies covered 241,138 participants. The studies came from 7 different countries and included both hospital- and community-based health care settings. When compared with acetaminophen, they found that ibuprofen reduced temperature at less than 4 hours (4 studies with 435 participants; standardized mean difference [SMD], 0.38; 95% CI, 0.08-0.67; 

 = 49%; moderate quality evidence) as well as at 4 to 24 hours (5 studies with 879 participants; SMD, 0.24; 95% CI, 0.03-0.45; P = .03; I2 = 57%; moderate-quality evidence).

Often what parents reach for to relieve a child’s pain or fever, a new meta-analysis looks at the efficacy and safety of ibuprofen and acetaminophen.

Ibuprofen Versus Acetaminophen Use in Children

Vaccine guidelines currently recommend the 3+1 diphtheria, tetanus, and acellular pertussis (DTaP) vaccine series for infants and toddlers, but coverage and timeliness of receiving the vaccines continues to be at less than optimal levels in the United States. A 

 at the virtual 2020 ID Week presented the results of a study that compared coverage and timeliness between DTaP-containing combination vaccines (ie, quadrivalent/pentavalent) and stand-alone vaccines (ie, trivalent).

The researchers developed a cohort of children who were born between 2009 and 2016 with >24 months of continuous enrollment from birth and a record of > 1 DTaP vaccine being administered. It was created using the Optum de-identified Clinformatics Data Mart database. The children were labelled by DTaP vaccine uptake: combination vaccines only, stand-alone vaccines only, or a mixture of both. Primary outcome for the study was completing a 4-dose series of DTaP by the time the patient was 20 months of age.

The cohort included 412,450 children, comprised of 200,568 girls (48.6%) and 211,882 boys (51.4%). Among these children, 167,091 were administered only combination vaccines; 61,342 children received the stand-alone vaccine only; and 184,017 members of the cohort were administered a mixture of stand-alone and combination vaccine doses. The researchers found that the completion of the 4-dose series was highest in children who had only received the combination vaccine (75.5%).

A poster at the virtual 2020 ID Week looked at how vaccine type can impact diphtheria, tetanus, and acellular pertussis (DTaP) vaccination.

Vaccine Type May Affect DTaP Adherence

The quest to reduce antibiotic resistance and to utilize antibiotic stewardship has been one of the biggest drives in medicine over the past decade. Research into the effect of exposure to antibiotics early in life has also led to a push to reduce the use in newborns and particularly in the neonatal intensive care unit. A 

 offers the results of a comprehensive quality improvement run in a level 4 neonatal intensive care unit that had the goal of decreasing the antibiotic use rate by 20%.

The investigators ran that initiative within the context a multicenter learning collaborative that was focused on reducing the unnecessary use of antibiotics. The strategies for improvement addressed the gaps seen in the core elements of antibiotic stewardship programs. Outcomes measured included the antibiotic use rate and the percentage of infants who were discharged without any exposure to antibiotics.

At the baseline of the quality initiative, the antibiotic use rate was 27.6% and it decreased to 15.5%, which was a 43% reduction in antibiotic use. The reduction was additionally maintained for >18 months. The investigators said that changes that had the biggest effect on this decrease included a 36-hour hard stop for antibiotics, a novel guideline for early-onset sepsis evaluation among infants <35 weeks, implementing a sepsis risk calculator, and adopting a 36-hour rule-out period for sepsis evaluation.

Controlling exposure to antibiotics is important for stewardship programs, and even more so in neonatal intensive care units.