Empyema rise as antibiotics fall

Rising rates of empyema among young children in the UK could be due to reduced antibiotic use by GPs, say experts.

Over the past 25 years rates of empyema have risen more than three-fold in children in Scotland, but the effect is independent of increasing rates of pneumonia, say researchers.

The findings are from a study of paediatric hospital admissions in Scotland for pneumonia and empyema between 1981 and 2005.

This showed that rates of empyema in the under-15s were stable until 1998, when a linear increase began to be seen.

Between 1998 and 2005, the rate of empyema admissions increased from fewer than 10 per million children per year to 37 per million children in 2005.

The problem is even more marked in children aged one to four. Up to 1998, the rate was around 6.5 per million per year, but by 2005 it was as high as 66 per million.

Overall admissions of pneumonia remained unchanged among most age groups. But in those aged one to four a steady increase was seen from 1981.

Similar increases in empyema have been reported in England.

Dr Kevin Gruffyd-Jones, Wiltshire GP and member of the General Practice Airways Group, said he has noticed an increase in empyema among young children in his practice.

'The reasons for this may be we're getting pathogenic organisms or that the pendulum has swung and we're diagnosing too many as being viral.

'There is a suggestion that we're overdiagnosing viral causes of pneumonia.'

Lead researcher of the study, Dr Stephen Turner, a consultant paediatrician at the Royal Aberdeen Children's Hospital, said: 'One potential solution is that GPs aren't prescribing enough antibiotics so we're seeing this rise.'

However, he added: 'I would have anticipated that if this was due to changes in GP prescribing we would have seen an increase in pneumonia, which we haven't.

'It could be that either the pathogen has got more virulent or the hosts have got more susceptible.'

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