今日の臨床サポート

上気道炎(かぜ症候群)(小児科)

著者: 児玉和彦 医療法人明雅会 こだま小児科

監修: 渡辺博 帝京大学老人保健センター

著者校正/監修レビュー済:2021/03/24
参考ガイドライン:
厚生労働省健康局結核感染症課:抗微生物薬適正使用の手引き第二版
患者向け説明資料

概要・推奨   

  1. 重症細菌感染症を見逃さないためには、PATPediatric Assessment triangleを用いて全身状態を評価し、熱源が不明な場合には白血球、CRPを検査することが不可欠である(推奨度1エビデンスレベルJ)。
  1. VPD(ワクチンで予防できる病気、vaccine preventable disease)のワクチンを適切な時期に確実に接種することが、安全で安心な医療を実践するための不可欠な要件である(推奨度1エビデンスレベルJ)
  1. ヒブと肺炎球菌ワクチン(プレベナー)の接種済みは重症細菌感染症の可能性を除外するものではない。発熱と眼瞼の発赤、腫脹は眼窩蜂窩織炎の可能性が高い(推奨度1エビデンスレベルO
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
児玉和彦 : 未申告[2021年]
監修:渡辺博 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 改訂された厚生労働省からの抗微生物薬適正使用のための手引きに基づき、重症感染症の診断や抗菌薬の投与量について改訂を行った。
  1. 髄膜炎関連ワクチン導入後の疫学データを定期レビューして更新した。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 上気道炎は鼻腔、咽頭、喉頭の呼吸器系ウイルス、一部細菌による急性感染症であるが、容易に下気道まで拡大し、病原体の種類にかかわらず発熱、咽頭痛、鼻汁、咳を中核症状とする共通の臨床像を呈することが多いため、「かぜ症候群」と1つにくくられる。
  1. 症状・所見、病態から、感冒、急性鼻咽頭炎、急性咽頭扁桃炎、急性副鼻腔炎、仮性クループ、あるいは急性喉頭炎などと細かく診断される場合もある。1つの病原体が複数の病態を起こし得るし、1つの病態が複数の病原体によって起こり得る[1][2][3]
  1. 「かぜ症候群」は小児、および成人の一般外来では最も患者数の多い疾患であるが、原因病原体の種類や頻度は季節や地域、年齢によって大きく変動する。
  1. 同じ病原体でも年齢や免疫の状態によって臨床像は大きく異なり、軽症の感冒から気管支炎、肺炎、そして脳炎・脳症まで多彩な病像を示す。
  1. 特異的な治療があるのはインフルエンザウイルス、A群β溶連菌、肺炎マイコプラズマ、肺炎クラミジア、百日咳だけであり、それ以外の病原体に対しては有効な薬剤はない。
  1. 発熱、咳、鼻汁、鼻閉などの症状は生体防衛反応であり[4][5][6]、原則として治療の必要はない。安静と保温、適切な食事・水分摂取を図ることが大切である。
  1. 上気道炎の多くは合併症がなければ10~14日ほどで自然に治癒する[7][8]
  1. 関連画像:
  1. かぜ症候群の各病態と原因病原体:<図表>
  1. 冬期の有熱性気道感染症:<図表>
  1. 夏期の有熱性気道感染症:<図表>
  1. 急性相のサイトカイン誘発反応:<図表>
  1. ヒトにおける急性相反応の神経内分泌反応:<図表>
問診・診察のポイント  
  1. 上気道炎(かぜ症候群)の可能性が高い場合でも、常にほかの重症疾患の可能性を考慮して問診・診察を進める。

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文献 

著者: Alastair D Hay, Andrew D Wilson
雑誌名: Br J Gen Pract. 2002 May;52(478):401-9.
Abstract/Text Professional and parental uncertainty regarding the natural history of cough and respiratory tract infection (R77) in pre-school children may in part be responsible for the high consultation, reconsultation, and antibiotic prescribing rates in this age group. The aim of the study was to review the evidence about the natural history of acute cough in children aged between 0 and 4 years presenting to primary care in terms of illness duration and complications. The study was a systematic review, with qualitative and quantitative data synthesis, of control and placebo arms of systematic reviews, randomised controlled trials (RCTs), and cohort studies set in primary care. Searches were done of MEDLINE (between 1966 and June 1998), EMBASE (between 1988 and September 1998), and the Cochrane Library databases, using the MeSH terms 'respiratory tract infection, 'cough, and 'bronchitis, and the textwords 'cough' 'bronchitis, and 'chest infection, limited to children aged between 0 and 4years, and English language articles. Eight RCTs and two cohort studies met the review criteria. At one week, 75% of children may have improved but 50% may be still coughing and/or have a nasal discharge. At two weeks up to 24% of children may be no better. Within two weeks of presentation, 12% of children may experience one or more complication, such as rash, painful ears, diarrhoea, vomiting, or progression to bronchitis/pneumonia. This review offers parents and clinicians more prognostic information about acute cough in pre-school children. Illness duration may be longer and complications higher than many parents and clinicians expect. This may help to set more realistic expectations of the illness and help parents to decide when and if to reconsult. This information may be useful to those designing patient information and self-help resources.

PMID 12014540  Br J Gen Pract. 2002 May;52(478):401-9.
著者: E R Wald, N Guerra, C Byers
雑誌名: Pediatrics. 1991 Feb;87(2):129-33.
Abstract/Text This study was performed to determine the usual duration of community-acquired viral upper respiratory tract infections and the incidence of complications (otitis media/sinusitis) of these respiratory tract infections in infancy and early childhood. Children in various forms of child-care arrangements (home care, group care, and day care) were enrolled at birth and observed for 3 years. Families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Only children remaining in their original child-care group for the entire study period were compared. The mean duration of an upper respiratory tract infection varied between 6.6 days (for 1- to 2-year-old children in home care) and 8.9 days (for children younger than 1 year in day care). The percentage of apparently simple upper respiratory tract infections that lasted more than 15 days ranged from 6.5% (for 1- to 3-year-old children in home care) to 13.1% (for 2- to 3-year-old children in day care). Children in day care were more likely than children in home care to have protracted respiratory symptoms. Of 2741 respiratory tract infections recorded for the 3-year period, 801 (29.2%) were complicated by otitis media. During the first 2 years of life, children in any type of day care were more likely than children in home care to have otitis media as a complication of upper respiratory tract infection. In year 3, the risk of otitis media was similar in all types of child care.

PMID 1987522  Pediatrics. 1991 Feb;87(2):129-33.
著者: Deniz Kesebir, Marietta Vazquez, Carla Weibel, Eugene D Shapiro, David Ferguson, Marie L Landry, Jeffrey S Kahn
雑誌名: J Infect Dis. 2006 Nov 1;194(9):1276-82. doi: 10.1086/508213. Epub 2006 Sep 26.
Abstract/Text BACKGROUND: Human bocavirus (HBoV) is a newly identified human parvovirus that was originally identified in the respiratory secretions of children with respiratory tract disease. To further investigate the epidemiological profile and clinical characteristics of HBoV infection, we screened infants and children <2 years of age (hereafter referred to as "children") for HBoV.
METHODS: Children for whom respiratory specimens submitted to a diagnostic laboratory tested negative for respiratory syncytial virus, parainfluenza viruses (types 1-3), influenza A and B viruses, and adenovirus, as well as asymptomatic children, underwent screening for HBoV by use of polymerase chain reaction (PCR). Respiratory specimens were obtained from the children from 1 January 2004 through 31 December 2004.
RESULTS: Twenty-two (5.2%) of the 425 children who had a respiratory specimen submitted to the diagnostic laboratory and 0 of the 96 asymptomatic children were found to be positive for HBoV by PCR (P=.02). Fever, rhinorrhea, cough, and wheezing were observed in > or =50% of the HBoV-positive children. Of the 17 children who had chest radiography performed, 12 (70.6%) had abnormal findings. HBoV appeared to have a seasonal distribution. Nucleotide polymorphisms were detected in the viral capsid protein (VP) 1/VP2 genes. Two distinct HBoV genotypes circulated during the study period.
CONCLUSIONS: HBoV is circulating in the United States and is associated with both upper and lower respiratory tract disease in infants and young children.

PMID 17041854  J Infect Dis. 2006 Nov 1;194(9):1276-82. doi: 10.1086/5・・・
著者: John C Arnold, Kumud K Singh, Stephen A Spector, Mark H Sawyer
雑誌名: Pediatrics. 2008 Mar;121(3):e631-7. doi: 10.1542/peds.2006-3073.
Abstract/Text OBJECTIVE: An estimated 12 to 32 million upper respiratory infections occur in young children each year. In addition, 20% to 53% of infants will have > or = 1 episode of lower respiratory infection in the first year of life. The current methods of diagnosing respiratory viruses are limited in scope and sensitivity. Polymerase chain reaction is a more sensitive method than antigen detection and is often used for newly discovered viruses. Using polymerase chain reaction, we sought to diagnose adenoviruses, human bocavirus, and human metapneumovirus at our children's hospital.
METHODS: Nasal-swab specimens submitted for antigen detection of respiratory viruses were collected and processed by using polymerase chain reaction to detect adenoviruses, human bocavirus, and human metapneumovirus. Inpatient and emergency department records were reviewed for clinical and demographic data.
RESULTS: Approximately 1500 specimens were collected over 21 months; they contained adenoviruses, human bocavirus, and human metapneumovirus in 5.9%, 5.6%, and 5.2% of children, respectively. Using polymerase chain reaction and antigen detection, a viral agent was identified in as many as 62% of the specimens. Lower respiratory tract disease was present most frequently in patients infected with human metapneumovirus (63%) and least frequently in those infected with adenoviruses (45%). We detected adenoviruses by polymerase chain reaction in 59 patients for whom the antigen-detection test results were negative. A paroxysmal cough led to clinical suspicion of Bordetella pertussis infection in 19% of patients infected with human bocavirus.
CONCLUSIONS: Adenoviruses, human bocavirus, and human metapneumovirus were each present in approximately 5% of specimens submitted for respiratory virus rapid testing. The lower respiratory tract was more commonly affected in patients with human bocavirus and human metapneumovirus infections. Adenovirus was often undiagnosed by antigen detection. Other findings included the presence of a pertussis-like illness associated with human bocavirus.

PMID 18310182  Pediatrics. 2008 Mar;121(3):e631-7. doi: 10.1542/peds.2・・・
著者: Jérôme O Wishaupt, Anne Russcher, Leo C Smeets, Florens G A Versteegh, Nico G Hartwig
雑誌名: Pediatrics. 2011 Nov;128(5):e1113-20. doi: 10.1542/peds.2010-2779. Epub 2011 Oct 10.
Abstract/Text OBJECTIVE: Real-time polymerase chain reaction (RT-PCR) testing is a quick sensitive method for detecting respiratory pathogens. We evaluated the diagnostic yield of RT-PCR assays and measured the effect of rapid reporting on patient care.
METHODS: In a controlled clinical trial, nasal wash specimens were obtained from patients <12 years of age with suspected acute respiratory infections. In addition to the standard hospital protocol, RT-PCR assays for 17 pathogens were performed. The RT-PCR results were communicated to the clinicians within 12 to 36 hours in the intervention group and after 4 weeks in the control group.
RESULTS: A total of 583 patients were included (mean age: 8.1 months [range: 0-107.5 months]): 298 in the intervention group and 285 in the control group. Eighty-two percent of nasal wash specimens tested positive for ≥1 pathogen. Respiratory syncytial virus was the most frequently encountered (55%) pathogen. There were no significant differences between the groups with respect to hospital admissions (intervention group: 223 admissions; control group: 211 admissions; P = .825), length of hospital stay (mean ± SD: 3.68 ± 2.68 days [intervention group] and 3.96 ± 2.67 days [control group]; P = .178), or duration of antibiotic use (mean ± SD: 6.52 ± 2.15 days [intervention group] and 6.97 ± 2.86 days [control group]; P = .490), when antibiotic treatment had been initiated.
CONCLUSIONS: RT-PCR testing has a high yield of viral diagnoses, but rapid communication does not lead to decreases in hospital admissions, shorter hospital stays, or less antibiotic use for children with acute respiratory infections.

PMID 21987698  Pediatrics. 2011 Nov;128(5):e1113-20. doi: 10.1542/peds・・・
著者: L J Baraff, J W Bass, G R Fleisher, J O Klein, G H McCracken, K R Powell, D L Schriger
雑誌名: Ann Emerg Med. 1993 Jul;22(7):1198-210.
Abstract/Text STUDY OBJECTIVE: To develop guidelines for the care of infants and children from birth to 36 months of age with fever without source.
PARTICIPANTS AND SETTING: An expert panel of senior academic faculty with expertise in pediatrics and infectious diseases or emergency medicine.
DESIGN AND INTERVENTION: A comprehensive literature search was used to identify all publications pertinent to the management of the febrile child. When appropriate, meta-analysis was used to combine the results of multiple studies. One or more specific management strategies were proposed for each of the decision nodes in draft management algorithms. The draft algorithms, selected publications, and the meta-analyses were provided to the panel, which determined the final guidelines using the modified Delphi technique.
RESULTS: All toxic-appearing infants and children and all febrile infants less than 28 days of age should be hospitalized for parenteral antibiotic therapy. Febrile infants 28 to 90 days of age defined at low risk by specific clinical and laboratory criteria may be managed as outpatients if close follow-up is assured. Older children with fever less than 39.0 C without source need no laboratory tests or antibiotics. Children 3 to 36 months of age with fever of 39.0 C or more and whose WBC count is 15,000/mm3 or more should have a blood culture and be treated with antibiotics pending culture results. Urine cultures should be obtained from all boys 6 months of age or less and all girls 2 years of age or less who are treated with antibiotics.
CONCLUSION: These guidelines do not eliminate all risk or strictly confine antibiotic treatment to children likely to have occult bacteremia. Physicians may individualize therapy based on clinical circumstances or adopt a variation of these guidelines based on a different interpretation of the evidence.

PMID 8517575  Ann Emerg Med. 1993 Jul;22(7):1198-210.
著者: J W Bass, R W Steele, R R Wittler, M E Weisse, V Bell, A H Heisser, J H Brien, J E Fajardo, G M Wasserman, J M Vincent
雑誌名: Pediatr Infect Dis J. 1993 Jun;12(6):466-73.
Abstract/Text This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID 8345978  Pediatr Infect Dis J. 1993 Jun;12(6):466-73.
著者: Rune Aabenhus, Jens-Ulrik S Jensen, Karsten Juhl Jørgensen, Asbjørn Hróbjartsson, Lars Bjerrum
雑誌名: Cochrane Database Syst Rev. 2014 Nov 6;(11):CD010130. doi: 10.1002/14651858.CD010130.pub2. Epub 2014 Nov 6.
Abstract/Text Background Acute respiratory infections (ARIs) are by far the most common reason for prescribing an antibiotic in primary care, even though the majority of ARIs are of viral or non-severe bacterial aetiology. Unnecessary antibiotic use will, in many cases, not be beneficial to the patients' recovery and expose them to potential side effects. Furthermore, as a causal link exists between antibiotic use and antibiotic resistance, reducing unnecessary antibiotic use is a key factor in controlling this important problem. Antibiotic resistance puts increasing burdens on healthcare services and renders patients at risk of future ineffective treatments, in turn increasing morbidity and mortality from infectious diseases. One strategy aiming to reduce antibiotic use in primary care is the guidance of antibiotic treatment by use of a point-of-care biomarker. A point-of-care biomarker of infection forms part of the acute phase response to acute tissue injury regardless of the aetiology (infection, trauma and inflammation) and may in the correct clinical context be used as a surrogate marker of infection,possibly assisting the doctor in the clinical management of ARIs.Objectives To assess the benefits and harms of point-of-care biomarker tests of infection to guide antibiotic treatment in patients presenting with symptoms of acute respiratory infections in primary care settings regardless of age.Search methods We searched CENTRAL (2013, Issue 12), MEDLINE (1946 to January 2014), EMBASE (2010 to January 2014), CINAHL (1981 to January 2014), Web of Science (1955 to January 2014) and LILACS (1982 to January 2014).Selection criteria We included randomised controlled trials (RCTs) in primary care patients with ARIs that compared use of point-of-care biomarkers with standard of care. We included trials that randomised individual patients as well as trials that randomised clusters of patients(cluster-RCTs).Two review authors independently extracted data on the following outcomes: i) impact on antibiotic use; ii) duration of and recovery from infection; iii) complications including the number of re-consultations, hospitalisations and mortality; iv) patient satisfaction. We assessed the risk of bias of all included trials and applied GRADE. We used random-effects meta-analyses when feasible. We further analysed results with a high level of heterogeneity in pre-specified subgroups of individually and cluster-RCTs.Main results The only point-of-care biomarker of infection currently available to primary care identified in this review was C-reactive protein. We included six trials (3284 participants; 139 children) that evaluated a C-reactive protein point-of-care test. The available information was from trials with a low to moderate risk of bias that address the main objectives of this review.Overall a reduction in the use of antibiotic treatments was found in the C-reactive protein group (631/1685) versus standard of care(785/1599). However, the high level of heterogeneity and the statistically significant test for subgroup differences between the three RCTs and three cluster-RCTs suggest that the results of the meta-analysis on antibiotic use should be interpreted with caution and the pooled effect estimate (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.66 to 0.92; I2 statistic = 68%) may not be meaningful.The observed heterogeneity disappeared in our pre planned subgroup analysis based on study design: RR 0.90, 95% CI 0.80 to 1.02; I2 statistic = 5% for RCTs and RR 0.68, 95% CI 0.61 to 0.75; I2 statistic = 0% for cluster-RCTs, suggesting that this was the cause of the observed heterogeneity.There was no difference between using a C-reactive protein point-of-care test and standard care in clinical recovery (defined as at least substantial improvement at day 7 and 28 or need for re-consultations day 28). However, we noted an increase in hospitalisations in the C-reactive protein group in one study, but this was based on few events and may be a chance finding. No deaths were reported in any of the included studies.We classified the quality of the evidence as moderate according to GRADE due to imprecision of the main effect estimate.Authors' conclusions A point-of-care biomarker (e.g. C-reactive protein) to guide antibiotic treatment of ARIs in primary care can reduce antibiotic use,although the degree of reduction remains uncertain. Used as an adjunct to a doctor's clinical examination this reduction in antibiotic use did not affect patient-reported outcomes, including recovery from and duration of illness.However, a possible increase in hospitalisations is of concern. A more precise effect estimate is needed to assess the costs of the intervention and compare the use of a point-of-care biomarker to other antibiotic-saving strategies.

PMID 25374293  Cochrane Database Syst Rev. 2014 Nov 6;(11):CD010130. d・・・
著者: Sami Pierre Moubayed, Thien-Tuong Vi Vu, Caroline Quach, Sam J Daniel
雑誌名: J Otolaryngol Head Neck Surg. 2011 Jun;40(3):266-70.
Abstract/Text OBJECTIVE: Since the advent of the Haemophilus influenzae type B vaccine, no North American case series has described periorbital cellulitis extensively as the main focus in the otolaryngology literature has been the management of orbital abscesses. The aim of this study was to describe the epidemiology, underlying causes, clinical presentation, and medical management of periorbital cellulitis.
STUDY DESIGN: Retrospective observational case series.
SETTING: Montreal Children's Hospital, McGill University Health Centre, a tertiary pediatric referral center in Montreal, Quebec.
SUBJECTS AND METHODS: The medical charts of all pediatric patients hospitalized from January 2000 to August 2006 with a discharge ICD-9 code indicating a diagnosis of periorbital cellulitis without abscess were reviewed. One hundred seventeen cases were identified.
RESULTS: Periorbital cellulitis in the pediatric population affects mainly preschool-aged patients (mean age 4.1 ± 4.2 years [SD]) and is more frequent among males than females (1.3:1). The most common predisposing conditions are sinusitis (24.8%), trauma (23.1%), and ocular conditions (13.7%). All patients were successfully managed with intravenous antibiotics for a mean period of 3.4 ± 2.6 days and oral antibiotics for 8.1 ± 4.4 days and recovered fully without complications.
CONCLUSION: Our results are consistent with the literature on the subject and show that timely identification of periorbital cellulitis cases and appropriate medical management result in resolution of the condition without complications.

PMID 21518652  J Otolaryngol Head Neck Surg. 2011 Jun;40(3):266-70.
著者: Cristina Baldassari, Rahul K Shah
雑誌名: Infect Disord Drug Targets. 2012 Aug;12(4):277-80.
Abstract/Text Peristonsillar abscess (PTA) is a common deep neck space infection in children. Children with PTA often present with sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus, and a muffled voice. The diagnosis of PTA can be made based on history and physical examination in the majority of children. Treatment of pediatric PTA necessitates aspiration or surgical drainage and antibiotic therapy. Challenges exist with the diagnosis and management of PTA that are unique to pediatric patients. Examples include difficulty with examination of the oropharynx in an uncooperative child and controversy surrounding bedside needle aspiration verses operative incision and drainage. Early identification of PTA and initiation of appropriate treatment can prevent serious complications.

PMID 22338588  Infect Disord Drug Targets. 2012 Aug;12(4):277-80.
著者: S F Dowell, B Schwartz, W R Phillips
雑誌名: Am Fam Physician. 1998 Oct 15;58(6):1335-42, 1345.
Abstract/Text This article summarizes the principles of judicious antimicrobial therapy for three of the five conditions--cough, pharyngitis, the common cold--that account for most of the outpatient use of these drugs in the United States. The principles governing the other two conditions, otitis media and acute sinusitis, were presented in the previous issue. This article summarizes evidence against the use of antibiotic treatment for illness with cough or bronchitis in children, unless the cough is prolonged. Although empiric treatment may be started in patients with pharyngitis when streptococcal infection is suspected, the authors recommend withholding antibiotic treatment until antigen testing or culture is positive. There is never any indication for antibiotic treatment of the common cold; it is important to understand the natural history of colds, because symptoms such as mucopurulent rhinitis or cough, even when they persist for up to two weeks, do not necessarily indicate bacterial infection.

PMID 9803198  Am Fam Physician. 1998 Oct 15;58(6):1335-42, 1345.
著者: D Felmingham, R N Grüneberg
雑誌名: J Antimicrob Chemother. 2000 Feb;45(2):191-203.
Abstract/Text The Alexander Project was established in 1992 to examine antimicrobial susceptibilities of bacterial isolates from community-acquired infections of the lower respiratory tract. Testing of a range of compounds was undertaken in a central laboratory. From 1992 to 1995, isolates were collected from geographically separated areas in countries in the European Union and various states in the USA. In 1996, the study was extended to include centres in Mexico, Brazil, Saudi Arabia, South Africa, Hong Kong and other European countries not included previously. Data generated by the project during 1996-1997 confirm France and Spain as European centres with high rates of resistance to penicillin among isolates of Streptococcus pneumoniae. Both intermediate (MIC 0. 12-1 mg/L) and resistant (MIC 2 mg/L) phenotypes are present. Combined resistance rates (intermediate and resistant) were >/=50% in 1997. Combined resistance rates in excess of 20% were found in the Republic of Ireland, Portugal, the Slovak Republic and Hungary. Penicillin resistance continues to evolve in the USA, with combined resistance rates of 16.4% (1996) and 18.6% (1997). In the new, non-European centres, e.g. Mexico and, in particular, Hong Kong (where resistant strains accounted for 50% of all isolates of S. pneumoniae in 1996 and 55.5% in 1997), there are centres where rates of resistance are high. Macrolide resistance is increasing generally among both penicillin-resistant and penicillin-susceptible isolates of S. pneumoniae. There is variation between countries, and in four out of the 16 centres for which both 1996 and 1997 data are available, rates of macrolide resistance have fallen. Overall, the percentage of S. pneumoniae strains that is resistant to macrolides exceeds the percentage that is resistant to penicillin. In 1996, 16. 5% of all S. pneumoniae isolates were resistant to macrolides compared with 10.4% resistant to penicillin, and in 1997 respective rates were 21.9% and 14.1%. beta-Lactamase production was the principal mechanism of resistance observed among isolates of Haemophilus influenzae. However, considerable variation in the percentage of isolates producing beta-lactamase (0-37.1%) was observed within this species. Within Europe, in the Republic of Ireland, France and Belgium, more than 15% of isolates were beta-lactamase producers. In Spain rates were as high as 31.7%. Outside Europe and the USA high rates were described in Mexico (25%), Saudi Arabia (27.9%, 16.7%) and Hong Kong (37.1%, 28.9%). Of H. influenzae from the USA, 30.4% were beta-lactamase producers in 1996 and 23.3% in 1997. beta-Lactamase production among isolates of Moraxella catarrhalis was observed in >90% of the isolates tested in 1996 and 1997.

PMID 10660501  J Antimicrob Chemother. 2000 Feb;45(2):191-203.
著者: O Cars, S Mölstad, A Melander
雑誌名: Lancet. 2001 Jun 9;357(9271):1851-3. doi: 10.1016/S0140-6736(00)04972-2.
Abstract/Text Data on antibiotic use are not publicly available in most European Union countries. We obtained data for non-hospital antibiotic sales for 1997 from the 15 member states and analysed these according to the Anatomic Therapeutic Chemical classification system, and expressed them as defined daily doses per 1000 people per day. Sales of antibiotics varied more than four-fold: France (36.5), Spain (32.4), Portugal (28.8), and Belgium (26.7) had the highest sales, whereas the Netherlands (8.9), Denmark (11.3), Sweden (13.5), and Germany (13.6) had the lowest. There was also profound variation in use of different classes of antibiotics. Detailed knowledge of antibiotic use is necessary to implement national strategies for optimum antibiotic use, and to address the threat posed by resistant microorganisms.

PMID 11410197  Lancet. 2001 Jun 9;357(9271):1851-3. doi: 10.1016/S0140・・・
著者: A M Gadomski
雑誌名: Pediatr Infect Dis J. 1993 Feb;12(2):115-20.
Abstract/Text Upper respiratory infections (URI) are a source of significant morbidity in childhood and have been associated with the development of certain bacterial infections. However, the high incidence of URI contrasted with the low incidence of lower respiratory infection (LRI) suggests a low rate of development of viral or bacterial LRI after URI. Because the etiology of URI is primarily viral, antibiotics do not have any significant effect on the URI episode itself but have been used to treat URI in hopes of preventing bacterial complications after URI. Meta-analysis of studies in developed and developing settings suggests that antibiotic treatment of children with URI does not shorten the course of URI and does not prevent the development of pneumonia. Several studies reporting both positive and negative results could not be included in the meta-analysis because they were not randomized trials or did not detail LRI outcomes in children sufficiently. Because of limitations in study design and definition of LRI, research in this area cannot be considered definitive. However, the weight of theoretical and experimental evidence is against antibiotic treatment of URI as a means of preventing the development of pneumonia after URI.

PMID 8426767  Pediatr Infect Dis J. 1993 Feb;12(2):115-20.
著者: M J Kluger, D H Ringler, M R Anver
雑誌名: Science. 1975 Apr 11;188(4184):166-8.
Abstract/Text The significance of fever in response to a bacterial infection has been investigated using the lizard Dipsosaurus dorsalis as an animal model. These lizards develop a fever of about 2 degrees C after injection with the bacterium Aeromonas hydrophila. To determine whether this elevation in body temperature increases the resistance of the host to this infection, as measured by survival, lizards were infected with the live bacteria and placed in a neutral (38 degrees C), low (34 degrees or 36 degrees C), or high (40 degrees or 42 degrees C) ambient temperature. An elevation in temperature following experimental bacterial infection results in a significant increase in host survival.

PMID 1114347  Science. 1975 Apr 11;188(4184):166-8.
著者: David King, Ben Mitchell, Christopher P Williams, Geoffrey K P Spurling
雑誌名: Cochrane Database Syst Rev. 2015 Apr 20;(4):CD006821. doi: 10.1002/14651858.CD006821.pub3. Epub 2015 Apr 20.
Abstract/Text BACKGROUND: Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and decongestant drugs and sometimes antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for URTI symptoms despite a relative lack of evidence for benefit in this clinical setting. This review is an update of the Cochrane review by Kassel et al, which found that saline was probably effective in reducing the severity of some symptoms associated with acute URTIs.
OBJECTIVES: To assess the effects of saline nasal irrigation for treating the symptoms of acute URTIs.
SEARCH METHODS: We searched CENTRAL (2014, Issue 7), MEDLINE (1966 to July week 5, 2014), EMBASE (1974 to August 2014), CINAHL (1982 to August 2014), AMED (1985 to August 2014) and LILACS (1982 to August 2014).
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs.
DATA COLLECTION AND ANALYSIS: Two review authors (DK, BM) independently assessed trial quality with the Cochrane 'Risk of bias' tool and extracted data. We analysed all data using the Cochrane Review Manager software. Due to the large variability of outcome measures only a small number of outcomes could be pooled for statistical analysis.
MAIN RESULTS: We identified five RCTs that randomised 544 children (three studies) and 205 adults (exclusively from two studies). They all compared saline irrigation to routine care or other nose sprays, rather than placebo. We included two new trials in this update, which did not contribute data of sufficient size or quality to materially change the original findings. Most trials were small and we judged them to be of low quality, contributing to an unclear risk of bias. Most outcome measures differed greatly between included studies and therefore could not be pooled. Most results showed no difference between nasal saline treatment and control. However, one larger trial, conducted with children, did show a significant reduction in nasal secretion score (mean difference (MD) -0.31, 95% confidence interval (CI) -0.48 to -0.14) and nasal breathing (obstruction) score (MD -0.33, 95% CI -0.47 to -0.19) in the saline group. However, a MD of -0.33 on a four-point symptom scale may have minimal clinical significance. The trial also showed a significant reduction in the use of decongestant medication by the saline group. Minor nasal discomfort and/or irritation was the only side effect reported by a minority of participants.
AUTHORS' CONCLUSIONS: Nasal saline irrigation possibly has benefits for relieving the symptoms of acute URTIs. However, the included trials were generally too small and had a high risk of bias, reducing confidence in the evidence supporting this. Future trials should involve larger numbers of participants and report standardised and clinically meaningful outcome measures.

PMID 25892369  Cochrane Database Syst Rev. 2015 Apr 20;(4):CD006821. d・・・
著者: Olabisi Oduwole, Ekong E Udoh, Angela Oyo-Ita, Martin M Meremikwu
雑誌名: Cochrane Database Syst Rev. 2018 Apr 10;4:CD007094. doi: 10.1002/14651858.CD007094.pub5. Epub 2018 Apr 10.
Abstract/Text BACKGROUND: Cough causes concern for parents and is a major cause of outpatient visits. Cough can impact quality of life, cause anxiety, and affect sleep in children and their parents. Honey has been used to alleviate cough symptoms. This is an update of reviews previously published in 2014, 2012, and 2010.
OBJECTIVES: To evaluate the effectiveness of honey for acute cough in children in ambulatory settings.
SEARCH METHODS: We searched CENTRAL (2018, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (2014 to 8 February 2018), Embase (2014 to 8 February 2018), CINAHL (2014 to 8 February 2018), EBSCO (2014 to 8 February 2018), Web of Science (2014 to 8 February 2018), and LILACS (2014 to 8 February 2018). We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trial Registry Platform (WHO ICTRP) on 12 February 2018. The 2014 review included searches of AMED and CAB Abstracts, but these were not searched for this update due to lack of institutional access.
SELECTION CRITERIA: Randomised controlled trials comparing honey alone, or in combination with antibiotics, versus no treatment, placebo, honey-based cough syrup, or other over-the-counter cough medications for children aged 12 months to 18 years for acute cough in ambulatory settings.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane.
MAIN RESULTS: We included six randomised controlled trials involving 899 children; we added three studies (331 children) in this update.We assessed two studies as at high risk of performance and detection bias; three studies as at unclear risk of attrition bias; and three studies as at unclear risk of other bias.Studies compared honey with dextromethorphan, diphenhydramine, salbutamol, bromelin (an enzyme from the Bromeliaceae (pineapple) family), no treatment, and placebo. Five studies used 7-point Likert scales to measure symptomatic relief of cough; one used an unclear 5-point scale. In all studies, low score indicated better cough symptom relief.Using a 7-point Likert scale, honey probably reduces cough frequency better than no treatment or placebo (no treatment: mean difference (MD) -1.05, 95% confidence interval (CI) -1.48 to -0.62; I² = 0%; 2 studies; 154 children; moderate-certainty evidence; placebo: MD -1.62, 95% CI -3.02 to -0.22; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Honey may have a similar effect as dextromethorphan in reducing cough frequency (MD -0.07, 95% CI -1.07 to 0.94; I² = 87%; 2 studies; 149 children; low-certainty evidence). Honey may be better than diphenhydramine in reducing cough frequency (MD -0.57, 95% CI -0.90 to -0.24; 1 study; 80 children; low-certainty evidence).Giving honey for up to three days is probably more effective in relieving cough symptoms compared with placebo or salbutamol. Beyond three days honey probably had no advantage over salbutamol or placebo in reducing cough severity, bothersome cough, and impact of cough on sleep for parents and children (moderate-certainty evidence). With a 5-point cough scale, there was probably little or no difference between the effects of honey and bromelin mixed with honey in reducing cough frequency and severity.Adverse events included nervousness, insomnia, and hyperactivity, experienced by seven children (9.3%) treated with honey and two children (2.7%) treated with dextromethorphan (risk ratio (RR) 2.94, 95% Cl 0.74 to 11.71; I² = 0%; 2 studies; 149 children; low-certainty evidence). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14, 95% Cl 0.01 to 2.68; 1 study; 80 children; low-certainty evidence). When honey was compared with placebo, 34 children (12%) in the honey group and 13 (11%) in the placebo group complained of gastrointestinal symptoms (RR 1.91, 95% CI 1.12 to 3.24; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Four children who received salbutamol had rashes compared to one child in the honey group (RR 0.19, 95% CI 0.02 to 1.63; 1 study; 100 children; moderate-certainty evidence). No adverse events were reported in the no-treatment group.
AUTHORS' CONCLUSIONS: Honey probably relieves cough symptoms to a greater extent than no treatment, diphenhydramine, and placebo, but may make little or no difference compared to dextromethorphan. Honey probably reduces cough duration better than placebo and salbutamol. There was no strong evidence for or against using honey. Most of the children received treatment for one night, which is a limitation to the results of this review. There was no difference in occurrence of adverse events between the honey and control arms.

PMID 29633783  Cochrane Database Syst Rev. 2018 Apr 10;4:CD007094. doi・・・
著者: A Waris, M Macharia, E K Njeru, F Essajee
雑誌名: East Afr Med J. 2014 Feb;91(2):50-6.
Abstract/Text BACKGROUND: Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies.
OBJECTIVE: To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough.
DESIGN: Randomised control trial.
SETTING: Aga Khan University Hospital Paediatric Casualty.
SUBJECTS: Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled.
OUTCOME MEASURES: Frequency, severity and extent to which cough bothered and disturbed child and parental sleep were assessed at baseline and over the subsequent five days through telephone interview using a validated scoring tool.
RESULTS: One hundred and forty five children were enrolled in the study (45- placebo, 57 -honey, 43 -salbutamol). Of the 145 children 51% were male. Honey significantly reduced the total mean symptom score by day three (p < 0.001). Total mean difference in scores between day zero to five demonstrated a significant difference of honey's efficacy over placebo (p < 0.002) however no difference was noted when compared to salbutamol (p < 0.478). Significant differences in both total as well as each individual symptom score was detected with honey consistently scoring the best whilst placebo and salbutamol scored the worst. In paired comparisons honey was superior to placebo but not salbutamol, whilst salbutamol was not superior to placebo.
CONCLUSION: Honey was most effective in symptomatic relief of symptoms associated with the common cold whilst salbutamol or placebo offered no benefit.

PMID 26859020  East Afr Med J. 2014 Feb;91(2):50-6.
著者: V L Gunn, S H Taha, E L Liebelt, J R Serwint
雑誌名: Pediatrics. 2001 Sep;108(3):E52.
Abstract/Text Over-the-counter (OTC) cough and cold medications are marketed widely for relief of common cold symptoms, and yet studies have failed to demonstrate a benefit of these medications for young children. In addition, OTC medications can be associated with significant morbidity and even mortality in both acute overdoses and when administered in correct doses for chronic periods of time. Physicians often do not inquire about OTC medication use, and parents (or other caregivers) often do not perceive OTCs as medications. We present 3 cases of adverse outcomes over a 13-month period-including 1 death-as a result of OTC cough and cold medication use. We explore the toxicities of OTC cough and cold medications, discuss mechanisms of dosing errors, and suggest why physicians should be more vigilant in specifically inquiring about OTCs when evaluating an ill child.

PMID 11533370  Pediatrics. 2001 Sep;108(3):E52.
著者: Mary E Rimsza, Susan Newberry
雑誌名: Pediatrics. 2008 Aug;122(2):e318-22. doi: 10.1542/peds.2007-3813.
Abstract/Text OBJECTIVE: The objective of this study was to determine whether caregivers had given infants who died unexpectedly over-the-counter cough and cold medications before the infant deaths to identify sociodemographic risk factors for their use.
METHODS: The Arizona Child Fatality Review Program reviews the circumstances surrounding every child death that occurs in the state each year. By statute, the multidisciplinary review teams have access to all medical charts, autopsy reports, law enforcement reports, and other records for their review and use these data to determine the cause of death and its preventability. The data on all infants who died unexpectedly in 2006 and had an autopsy and postmortem toxicologic studies were reviewed for this analysis.
RESULTS: Ten unexpected infant deaths that were associated with cold-medication use were identified. The infants ranged in age from 17 days to 10 months. Postmortem toxicology testing found evidence of recent administration of pseudoephedrine, antihistamine, dextromethorphan, and/or other cold-medication ingredients in these infants. The families who used these medications were poor and publicly insured, and 50% of them had limited English proficiency. Only 4 of these infants had received medical care for their current illness before their death. The over-the-counter cough and cold medication had been prescribed by a clinician for only 1 of these infants.
CONCLUSIONS: Review of these infants' deaths raises concern about the role of the over-the-counter cough and cold medications in these deaths. These findings support the recommendation that such medications not be given to infants. In addition, these findings suggest that warnings on these medications "to consult a clinician" before use are not being followed by parents. Educational campaigns to decrease the use of over-the-counter cough and cold medications in infants need to be increased.

PMID 18676517  Pediatrics. 2008 Aug;122(2):e318-22. doi: 10.1542/peds.・・・
著者: Damien G Finniss, Ted J Kaptchuk, Franklin Miller, Fabrizio Benedetti
雑誌名: Lancet. 2010 Feb 20;375(9715):686-95. doi: 10.1016/S0140-6736(09)61706-2.
Abstract/Text For many years, placebos have been defined by their inert content and their use as controls in clinical trials and treatments in clinical practice. Recent research shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings. There is also evidence that placebo effects can exist in clinical practice, even if no placebo is given. Further promotion and integration of laboratory and clinical research will allow advances in the ethical use of placebo mechanisms that are inherent in routine clinical care, and encourage the use of treatments that stimulate placebo effects.

Copyright 2010 Elsevier Ltd. All rights reserved.
PMID 20171404  Lancet. 2010 Feb 20;375(9715):686-95. doi: 10.1016/S014・・・
著者: Hiroya Hasegawa, Soichiro Okubo, Yohei Ikezumi, Kumiko Uchiyama, Toru Hirokawa, Harunobu Hirano, Makoto Uchiyama
雑誌名: Pediatr Nephrol. 2009 Mar;24(3):507-11. doi: 10.1007/s00467-008-1053-1. Epub 2008 Dec 2.
Abstract/Text Hypotonic fluids are commonly used for treating hospitalized children. However, an excess of arginine vasopressin (AVP) with impaired free water excretion is thought to contribute to the development of hyponatremia in febrile children. The aim of this two-part study was to define the clinical relationship between hyponatremia and excess AVP. In a retrospective study carried out between 2001 and 2005, we found that approximately 17% of the hospitalized patients had hyponatremia [serum sodium (Na) < 135 mEq/l] upon admission and that the ratio of patients with hyponatremia was significantly higher among febrile patients than among afebrile patients. In a subsequent prospective study, we examined 73 hospitalized patients who presented with acute febrile diseases accompanied by hyponatremia (serum Na <134 mEq/l). Almost all of these patients demonstrated excess AVP, defined as high plasma AVP levels (>1 pg/ml). There were no significant relationships between the levels of AVP and other laboratory variables, including serum sodium, serum osmolality, atrial natriuretic peptide, and brain natriuretic peptide. About 30% (22/73) of the patients fulfilled the criteria of the syndrome of inappropriate secretion of antidiuretic hormone. These findings suggest that fever and other nonosmotic stimuli lead directly to excess AVP and hyponatremia. We therefore recommend that isotonic fluids should be used for patients with prolonged fever and hyponatremia.

PMID 19048300  Pediatr Nephrol. 2009 Mar;24(3):507-11. doi: 10.1007/s0・・・
著者: T Kiviranta, L Tuomisto, E M Airaksinen
雑誌名: Eur J Pediatr. 1996 Feb;155(2):120-5.
Abstract/Text UNLABELLED: During acute febrile diseases mild disturbances of water and electrolyte balance occur frequently. It has been suggested that changes in electrolyte balance, in particular hyponatraemia, might predispose a child to convulsions during febrile illness; however, the changes of electrolytes in the CSF are not known. We have studied the effects of fever and convulsions on water and electrolyte balance in CSF and serum by measuring osmolality and electrolyte concentrations in children. The febrile population consisted of 60 children, 36 of whom had seizures during fever. Twenty-one children without convulsions and nine children with epileptic symptoms were nonfebrile controls. We noticed that CSF is subject to changes in osmolality and electrolyte concentration during fever, while convulsions do not exhibit such changes. CSF osmolality and sodium concentrations were lower in febrile children than in nonfebrile controls. The osmolality in febrile children with convulsions was 3.8% (P < 0.01) and without seizures 3.5% (P < 0.01) lower than in nonfebrile nonconvulsive children. The changes in CSF sodium concentration, and to a lesser extent potassium and chloride concentrations, paralleled those of CSF osmolality. A positive correlation was observed between the CSF and serum osmolatities (r = 0.73, P < 0.0001), and sodium concentrations (r = 0.63, P < 0.0001). A negative correlation between the body temperature and both CSF osmolality (r = -0.66, P < 0.0001) and sodium concentration (r = -0.59, P < 0.0001) exhibits also the important regulative role of increased body temperature.
CONCLUSION: Fever is an important factor for disturbances in fluid and electrolyte balance. The alterations in CSF osmolality and sodium concentration do not, however, give an unambiguous explanation for the susceptibility to simple febrile seizures.

PMID 8775227  Eur J Pediatr. 1996 Feb;155(2):120-5.
著者: Michelle Pb Guppy, Sharon M Mickan, Chris B Del Mar, Sarah Thorning, Alexander Rack
雑誌名: Cochrane Database Syst Rev. 2011 Feb 16;(2):CD004419. doi: 10.1002/14651858.CD004419.pub3. Epub 2011 Feb 16.
Abstract/Text BACKGROUND: Acute respiratory infection is a common reason for people to present for medical care. Advice to increase fluid intake is a frequent treatment recommendation. Attributed benefits of fluids include replacing increased insensible fluid losses, correcting dehydration from reduced intake and reducing the viscosity of mucus. However, there are theoretical reasons for increased fluid intake to cause harm. Anti-diuretic hormone secretion is increased in lower respiratory tract infections of various aetiologies. This systematic examination of the evidence sought to determine the benefit versus harm from increasing fluid intake.
OBJECTIVES: To answer the following questions.1. Does recommending increased fluid intake as a treatment for acute respiratory infections improve duration and severity of symptoms? 2. Are there adverse effects from recommending increased fluids in people with acute respiratory infections? 3. Are any benefits or harms related to site of infection (upper or lower respiratory tract) or a different severity of illness?
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, issue 4), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to November Week 3, 2010), EMBASE (1974 to December 2010), Current Contents (2000 to December 2010) and CINAHL (1982 to December 2010). We searched reference lists of articles identified and contacted experts in the relevant disciplines.
SELECTION CRITERIA: Randomised controlled trials (RCTs) that examined the effect of increasing fluid intake in people with acute respiratory infections.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the identified studies to determine eligibility for inclusion.
MAIN RESULTS: No RCTs assessing the effect of increasing fluid intake in acute respiratory infections were found.
AUTHORS' CONCLUSIONS: There is currently no evidence from RCTs for or against the recommendation to increase fluids in acute respiratory infections. The implications for fluid management of acute respiratory infections in the outpatient or primary care setting have not been studied in any RCTs to date. Some non-experimental (observational) studies report that increasing fluid intake in acute respiratory infections of the lower respiratory tract may cause harm. RCTs need to be done to determine the true effect of this very common medical advice.

PMID 21328268  Cochrane Database Syst Rev. 2011 Feb 16;(2):CD004419. d・・・
著者: Massimiliano Don, Giuliana Valerio, Matti Korppi, Mario Canciani
雑誌名: Pediatr Nephrol. 2008 Dec;23(12):2247-53. doi: 10.1007/s00467-008-0910-2. Epub 2008 Jul 8.
Abstract/Text Studies focusing on serum sodium disorders in children with community-acquired-pneumonia (CAP) are nearly entirely lacking, though clinical experience suggests that at least hyponatremia (HN) might be rather common. We evaluated the incidence of hypo- and hypernatremia, in relation to other clinical, laboratory and etiological findings, in pediatric CAP. Serum sodium concentration was measured in 108 ambulatory and hospitalized children with radiologically confirmed CAP of variable severity. The etiology of CAP was revealed by serology in 97 patients. HN (serum sodium < 135 mmol/l) was present in 49 (45.4%) children, and it was mild (> 130 mmol/l) in 92% of the cases. On admission, hyponatremic patients had higher body temperature (38.96 degrees C vs 38.45 degrees C, P = 0.008), white blood cell count (21,074/microl vs 16,592/microl, P = 0.008), neutrophil percentage (78.93% vs 69.33%, P = 0.0001), serum C-reactive protein (168.27 mg/l vs 104.75 mg/l, P = 0.014), and serum procalcitonin (22.35 ng/ml vs 6.87 ng/ml, P = 0.0001), and lower calculated osmolality (263.39 mosmol/l vs 272.84 mosmol/l, P = 0.0001) than normonatremic ones. No association was found with plasma glucose, type of radiological consolidation or etiology of CAP. HN is common but usually mild in children with CAP. HN seems to be associated with the severity of CAP, assessed by fever, need of hospitalization and serum non-specific inflammatory markers.

PMID 18607640  Pediatr Nephrol. 2008 Dec;23(12):2247-53. doi: 10.1007/・・・
著者: G Grateau
雑誌名: Rheumatology (Oxford). 2004 Apr;43(4):410-5. doi: 10.1093/rheumatology/keh157. Epub 2004 Feb 24.
Abstract/Text Hereditary periodic fever syndromes are a group of diseases characterized by intermittent bouts of clinical inflammation with focal organ involvement, mainly of the abdomen, musculoskeletal system and skin. The most frequent is familial Mediterranean fever, which affects patients of Mediterranean descent all over the world. Three other types have recently been characterized clinically and genetically. A thorough diagnosis is warranted, as clinical and therapeutic management is specific for each of these diseases. The underlying mechanisms of these inflammatory diseases appear to be specific for each type, involving so far unknown proteins, and have already opened new avenues in our understanding of the inflammatory response.

PMID 14983109  Rheumatology (Oxford). 2004 Apr;43(4):410-5. doi: 10.10・・・
著者: Takafumi Okada, Yoshitake Sato, Yoshikiyo Toyonaga, Hideaki Hanaki, Keisuke Sunakawa
雑誌名: Pediatr Int. 2016 Mar;58(3):192-201. doi: 10.1111/ped.12781. Epub 2016 Feb 19.
Abstract/Text BACKGROUND: Streptococcus pneumoniae is a major causative pathogen of pneumonia in children. The Drug-Resistant Pathogen Surveillance Group in Pediatric Infectious Disease conducted a nationwide surveillance of S. pneumoniae in 2000-2001, 2004, 2007, 2010 and 2012, and investigated changes in drug resistance of S. pneumoniae.
METHODS: All strains of S. pneumoniae were isolated from clinical specimens collected from pediatric patients. The minimun inhibitory concentration was measured and the strains were classified according to the Clinical Laboratory Standards Institute criteria. The isolation rates of penicillin-intermediate resistant S. pneumoniae (PISP) and penicillin-resistant S. pneumoniae (PRSP) were compared based on seven patient factors. Logistic regression analysis was also performed.
RESULTS: The sum of the isolation rates for PISP and PRSP for each period was 64.6%, 67.0%, 56.2%, 76.9% and 49.5%, respectively. Among the patient factors, age category 1 (<3 years, ≥3 years), age category 2 (infant, toddler and preschooler, schoolchild), siblings (absence, presence), and pre-treatment with antimicrobial agents (absence, presence) were associated with significant differences in the isolation rate of PISP + PRSP. An interaction was observed between pre-treatment with antimicrobial agents and schoolchild, and the isolation rate of PISP + PRSP was higher in patients with both pre-treatment with antimicrobial agents and schoolchild.
CONCLUSION: Although some changes were observed in the rate of resistance of S. pneumoniae, an increasing trend was not observed. Both pre-treatment with antimicrobial agents and age were associated with resistance, and an interaction was observed between pre-treatment with antimicrobial agents and schoolchild.

© 2015 The Authors. Pediatrics International published by John Wiley & Sons Australia, Ltd on behalf of Japan Pediatric Society.
PMID 26259099  Pediatr Int. 2016 Mar;58(3):192-201. doi: 10.1111/ped.1・・・

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