{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:55:34Z","timestamp":1793228134491,"version":"4.5.0"},"reference-count":96,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","license":[{"start":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T00:00:00Z","timestamp":1701820800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Severe bacterial infections in children need prompt, appropriate antibiotic treatment. We report challenges observed within a prospective, cohort study on antibiotic efficacy in non-typhi\n                    <jats:italic>Salmonella<\/jats:italic>\n                    bloodstream infection (NCT04850677) in Kisantu district hospital (Democratic Republic of Congo). Children (aged &gt;\u00a028\u2009days to &lt;\u00a05\u2009years) admitted with suspected bloodstream infection (August 1, 2021 through July 31, 2022) were enrolled and followed until day 3 or discharge for non-typhi\n                    <jats:italic>Salmonella<\/jats:italic>\n                    patients. Antibiotics were administered to 98.4% (1,838\/1,867) of children, accounting for 2,296 antibiotic regimens (95.7% intravenous, 4.3% oral). Only 78.3% and 61.8% of children were, respectively, prescribed and administered antibiotics on the admission day. At least one dose was not administered in 3.6% of children, mostly because of mismatch of the four times daily cefotaxime schedule with the twice-daily administration rounds. Inappropriate intravenous administration practices included multidose use, air-venting, and direct injection instead of perfusion. There was inaccurate aliquoting in 18.0% (32\/178) of intravenous ciprofloxacin regimens, and thus administered doses were &gt;\u00a016% below the intended dose. Dosing accuracy of oral suspensions was impaired by lack of instructions for reconstitution, volume indicators, and\/or dosing devices. Adult-dose tablets were split without\/beyond scoring lines in 84.4% (27\/32) of tablets. Poor availability and affordability of age-appropriate oral formulations contributed to low proportions of intravenous-to-oral switch (33.3% (79\/237) of non-typhi\n                    <jats:italic>Salmonella<\/jats:italic>\n                    patients). Other quality issues included poor packaging, nonhomogeneous suspensions, and unsafe water for reconstitution. In conclusion, poor antibiotic products (no age-appropriate formulations, poor quality and access), processes (delayed prescription\/administration, missed doses), and practices (inaccurate doses, [bio]safety risks) must be urgently addressed to improve pediatric antibiotic treatment.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.23-0322","type":"journal-article","created":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T11:06:42Z","timestamp":1698664002000},"page":"1245-1259","source":"Crossref","is-referenced-by-count":7,"title":["Challenges of Antibiotic Formulations and Administration in the Treatment of Bloodstream Infections in Children Under Five Admitted to Kisantu Hospital, Democratic Republic of Congo"],"prefix":"10.4269","volume":"109","author":[{"given":"Bieke","family":"Tack","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;"},{"name":"Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium;"},{"name":"Department of Pediatrics, KU Leuven University Hospitals Leuven, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Vita","sequence":"additional","affiliation":[{"name":"Saint Luc H\u00f4pital G\u00e9n\u00e9ral de R\u00e9f\u00e9rence Kisantu, Democratic Republic of Congo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Ntangu","sequence":"additional","affiliation":[{"name":"Saint Luc H\u00f4pital G\u00e9n\u00e9ral de R\u00e9f\u00e9rence Kisantu, Democratic Republic of Congo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Japhet","family":"Ngina","sequence":"additional","affiliation":[{"name":"Saint Luc H\u00f4pital G\u00e9n\u00e9ral de R\u00e9f\u00e9rence Kisantu, Democratic Republic of Congo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pathy","family":"Mukoko","sequence":"additional","affiliation":[{"name":"Saint Luc H\u00f4pital G\u00e9n\u00e9ral de R\u00e9f\u00e9rence Kisantu, Democratic Republic of Congo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ad\u00e8le","family":"Lutumba","sequence":"additional","affiliation":[{"name":"Saint Luc H\u00f4pital G\u00e9n\u00e9ral de R\u00e9f\u00e9rence Kisantu, Democratic Republic of Congo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Vangeluwe","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Vacances, Mechelen, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaan","family":"Toelen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, KU Leuven University Hospitals Leuven, Belgium;"},{"name":"Department of Development and Regeneration, KU Leuven, Leuven, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Allegaert","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, KU Leuven, Leuven, Belgium;"},{"name":"Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium;"},{"name":"Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavie","family":"Lunguya","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Institut National de Recherche Biom\u00e9dicale, Kinshasa, Democratic Republic of Congo;"},{"name":"Department of Medical Biology, University Teaching Hospital of Kinshasa, Democratic Republic of Congo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Ravinetto","sequence":"additional","affiliation":[{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;"},{"name":"School of Public Health, University of the Western Cape, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;"},{"name":"Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"3027","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201315: an updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"Liu","year":"2016"},{"key":"b2","series-title":"Clin Microbiol Infect","first-page":"808","article-title":"The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management","volume":"24","author":"Maze","year":"2018"},{"key":"b3","series-title":"Lancet","first-page":"629","article-title":"Global 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