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Article ; Online: Incidence of amoxycillin-clavulanic acid associated hepatotoxicity in an Australian children's hospital.

Eldredge, Jessica A / Pittet, Laure F / Gwee, Amanda

The Journal of antimicrobial chemotherapy

2024 Volume 79, Issue 3, Page(s) 589–594

Abstract: Objectives: Amoxycillin/clavulanic acid is the most common antimicrobial cause of drug-induced liver injury in adults. It is a less common cause of severe drug-related hepatotoxicity in children despite its frequent use. We studied the incidence, ... ...

Abstract	Objectives: Amoxycillin/clavulanic acid is the most common antimicrobial cause of drug-induced liver injury in adults. It is a less common cause of severe drug-related hepatotoxicity in children despite its frequent use. We studied the incidence, characteristics and predictive factors for amoxycillin/clavulanic acid hepatoxicity in children. Design: Retrospective cohort study of children who received oral or intravenous amoxycillin/clavulanic acid at a quaternary children's hospital over a 5-year period. Children were included if they had liver function tests (LFTs) determined at baseline, during and within 3 months after the treatment course. Causality was assessed using the Naranjo criteria for adverse drug reactions and Roussel Uclaf Causality Assessment Method. Results: Of 3271 children prescribed amoxycillin/clavulanic acid, 374 were included. Forty-nine (13%) had LFT abnormalities related to amoxycillin/clavulanic acid. Fourteen (3.6%) fulfilled Common Terminology Criteria for Adverse Events (CTCAE) grade 2 criteria with clinically significant hepatotoxicity. Age <2 years, sepsis, post-gastrointestinal surgical indications, prolonged treatment course of >7 days and higher cumulative amoxycillin (>10 g) and clavulanic acid dose (>1 g) were predictive of hepatotoxicity. The median time to resolution of LFT abnormalities was 4 weeks (range 3-7). Conclusions: The incidence of amoxycillin/clavulanic acid related LFT abnormalities (CTCAE Grade 2 or above) in children was 3.6%. A prolonged treatment course >7 days, high cumulative amoxycillin (10 g) and clavulanic acid (>1 g) doses, those aged <2 years, and patients with sepsis or post-gastrointestinal surgery were predictive of a higher likelihood of abnormal LFTs. LFT monitoring should be considered in children receiving ≥7 days of treatment, particularly in those with other predisposing factors.
MeSH term(s)	Adult ; Child ; Humans ; Amoxicillin-Potassium Clavulanate Combination/adverse effects ; Clavulanic Acids/adverse effects ; Incidence ; Retrospective Studies ; Drug Therapy, Combination ; Australia/epidemiology ; Amoxicillin/pharmacology ; Clavulanic Acid/adverse effects ; Sepsis/drug therapy ; Drug-Related Side Effects and Adverse Reactions/etiology ; Chemical and Drug Induced Liver Injury/epidemiology ; Chemical and Drug Induced Liver Injury/etiology ; Hospitals
Chemical Substances	Amoxicillin-Potassium Clavulanate Combination (74469-00-4) ; Clavulanic Acids ; Amoxicillin (804826J2HU) ; Clavulanic Acid (23521W1S24)
Language	English
Publishing date	2024-02-01
Publishing country	England
Document type	Journal Article
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkae009
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Zs.A 1197: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 124: Show issues

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Article ; Online: The Sensitivity and Specificity of Procalcitonin in Diagnosing Bacterial Sepsis in Neonates.

Beaumont, Rachael / Tang, Kailey / Gwee, Amanda

Hospital pediatrics

2024 Volume 14, Issue 3, Page(s) 199–208

Abstract: Context and objectives: Neonatal sepsis accounts for 15% of all neonatal deaths. Early detection enables prompt administration of antibiotic treatment, reducing morbidity and mortality. This study aims to review the sensitivity and specificity of ... ...

Abstract	Context and objectives: Neonatal sepsis accounts for 15% of all neonatal deaths. Early detection enables prompt administration of antibiotic treatment, reducing morbidity and mortality. This study aims to review the sensitivity and specificity of procalcitonin in diagnosing microbiologically-proven sepsis in neonates to determine the optimal procalcitonin cut-off value for use in clinical practice. Data sources, study selection, and data extraction: Medline, EMBASE and PubMed were searched on 3 May 2023 for original studies in symptomatic neonates in whom both blood culture and procalcitonin levels were taken, and a procalcitonin cut-off with either sensitivity or specificity reported. Studies that included asymptomatic or culture-negative neonates in the proven sepsis group were excluded. Risk of bias was assessed using the Qualitative Assessment of Diagnostic Accuracy Studies 2 tool. Results: Nineteen original studies enrolling a total of 1920 symptomatic neonates (721 with proven sepsis) were included. Six studies used a procalcitonin cut-off of 0.5 ng/mL and found a sensitivity of 87% to 100% and specificity of 17% to 89%. Nine studies evaluated higher procalcitonin cut-off values between 0.99 ng/mL and 2 ng/mL, which were 67% to 98% sensitive and 41% to 89% specific. All other procalcitonin thresholds were neither sensitive nor specific. Meta-analysis was not performed because of high risk of bias within the identified studies. Conclusions: This review found that procalcitonin was highly sensitive (87% to 100%) at a cut-off value of 0.5 ng/mL, although specificity varied greatly across all cut-off values reviewed. The variation in diagnostic accuracy between studies suggests that procalcitonin may be useful to guide antibiotic cessation but should not be used alone as a diagnostic marker for neonatal sepsis.
MeSH term(s)	Infant, Newborn ; Humans ; Procalcitonin ; Neonatal Sepsis/diagnosis ; Biomarkers ; C-Reactive Protein ; Sepsis/diagnosis ; Sepsis/microbiology ; Anti-Bacterial Agents
Chemical Substances	Procalcitonin ; Biomarkers ; C-Reactive Protein (9007-41-4) ; Anti-Bacterial Agents
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Review ; Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007318
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Article ; Online: Clinical pharmacological considerations in an early intravenous to oral antibiotic switch: are barriers real or simply perceived?

Landersdorfer, Cornelia B / Gwee, Amanda / Nation, Roger L

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

2023 Volume 29, Issue 9, Page(s) 1120–1125

Abstract: Background: Traditionally, there has been a common belief that ongoing i.v. antibiotic therapy is superior to an early i.v. to oral switch, especially for severe infections. However, this may be at least partly based on early observations rather than ... ...

Abstract	Background: Traditionally, there has been a common belief that ongoing i.v. antibiotic therapy is superior to an early i.v. to oral switch, especially for severe infections. However, this may be at least partly based on early observations rather than robust, high-quality data and contemporary clinical studies. It is important to examine whether these traditional views align with clinical pharmacological considerations, or conversely, if these considerations may support the broader application of an early i.v. to oral switch under appropriate circumstances. Objectives: To examine the rationale for an early i.v. to oral antibiotic switch in the context of clinical pharmacokinetic and pharmacodynamic principles and to discuss whether commonly encountered pharmacological barriers are real or simply perceived. Sources: We conducted PubMed searches on barriers and clinicians' perceptions about an early i.v. to oral switch, clinical studies comparing switching with i.v.-only dosing, and pharmacological factors affecting oral antimicrobials. Content: We focused on general pharmacological and clinical pharmacokinetic and pharmacodynamic principles and considerations that are relevant when clinicians ponder whether to switch from i.v. to oral antimicrobial dosing. The main focus of this review was on antibiotics. The discussion of the general principles is accompanied by specific examples from the literature. Implications: Clinical pharmacological considerations and an imposing and increasing number of clinical studies, including randomized clinical trials, support an early i.v. to oral switch for the treatment of a number of infection types, under appropriate circumstances. We hope that the information provided here will add to calls for a critical examination of the role of i.v. to oral switching for many infections that are currently treated almost exclusively with i.v.-only therapy, and that it will inform health policy and guideline development by infectious diseases organizations.
MeSH term(s)	Humans ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Administration, Intravenous ; Anti-Infective Agents/therapeutic use ; Administration, Oral
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents
Language	English
Publishing date	2023-04-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1328418-6
ISSN	1469-0691 ; 1470-9465 ; 1198-743X
ISSN (online)	1469-0691
ISSN	1470-9465 ; 1198-743X
DOI	10.1016/j.cmi.2023.04.009
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Zs.A 4541: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 284: Show issues

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Article ; Online: Teicoplanin Therapeutic Drug Monitoring and Treatment Outcomes in Children With Gram-Positive Infections.

Loane, Georgia / Gwee, Amanda

Journal of the Pediatric Infectious Diseases Society

2021 Volume 10, Issue 5, Page(s) 682–685

Abstract: This is a retrospective audit of teicoplanin dosing, drug-level monitoring, and outcomes in 29 children who received 31 courses of teicoplanin. Our study of noncritically ill children showed that the majority (35/43, 81%) of trough concentrations were ... ...

Abstract	This is a retrospective audit of teicoplanin dosing, drug-level monitoring, and outcomes in 29 children who received 31 courses of teicoplanin. Our study of noncritically ill children showed that the majority (35/43, 81%) of trough concentrations were within the therapeutic range (10-30 mg/L) contrasting previous studies in children. Overall, 21 of the 24 (88%) children with Gram-positive infections achieved cure.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Child ; Drug Monitoring ; Humans ; Retrospective Studies ; Teicoplanin/therapeutic use ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents ; Teicoplanin (61036-62-2)
Language	English
Publishing date	2021-03-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2668791-4
ISSN	2048-7207 ; 2048-7193
ISSN (online)	2048-7207
ISSN	2048-7193
DOI	10.1093/jpids/piab005
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Article ; Online: Posaconazole in paediatric malignancy and haematopoietic stem cell transplant: dosing to achieve therapeutic concentration.

Weerdenburg, Heather / Walker, Hannah / Curtis, Nigel / Duffull, Stephen / Haeusler, Gabrielle / Cole, Theresa / Gwee, Amanda

The Journal of antimicrobial chemotherapy

2024

Abstract: Objectives: Posaconazole is increasingly used for the treatment and prophylaxis of invasive fungal infections in immunocompromised children. We aimed to review evidence for paediatric posaconazole dosing regimens focusing on attainment of target ... ...

Abstract	Objectives: Posaconazole is increasingly used for the treatment and prophylaxis of invasive fungal infections in immunocompromised children. We aimed to review evidence for paediatric posaconazole dosing regimens focusing on attainment of target concentrations and frequency of adverse effects. Methods: In May 2023, the Cochrane, Embase, MEDLINE and PubMed databases were searched for articles reporting posaconazole dosing in children with malignancy or post-haematopoietic stem cell transplantation. Studies reporting the attainment of target serum concentrations were included. Results: Overall, 24 studies were included. Eighteen studies of the oral suspension consistently reported poor attainment of target concentrations for prophylaxis (≥0.7 µg/mL, 12%-78%) despite high daily doses of 14-23 mg/kg/day (max. 1200 mg/day). Target attainment was significantly affected by gastric pH and food intake. Six studies of the delayed-release tablet (DRT) reported 58%-94% achieved concentrations ≥0.7 µg/mL, with the majority using lower doses of 4-12 mg/kg/day (max. 300 mg/day). Similarly, one study of powder for oral suspension found 67%-100% achieved target concentrations with a dose of 6 mg/kg/day (max. 300 mg/day). As expected, the IV formulation had high attainment of prophylaxis targets (81%-90%) with 6-10 mg/kg/day (max. 400 mg/day). All formulations were well tolerated, and no relationship between adverse effects and posaconazole concentrations was identified. Conclusions: The required posaconazole dose in immunocompromised children varies depending on the formulation. The IV infusion had the highest attainment of therapeutic concentration followed by the DRT and powder for suspension. By contrast, the oral suspension had low attainment of target concentrations despite higher daily doses.
Language	English
Publishing date	2024-04-18
Publishing country	England
Document type	Journal Article
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkae099
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Zs.A 1197: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 124: Show issues

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Article ; Online: Incidence and predisposing factors for flucloxacillin-related hepatotoxicity in children.

Coombs, Stefan / Pittet, Laure F / Tang, Kailey / Gwee, Amanda

The Journal of antimicrobial chemotherapy

2023 Volume 78, Issue 11, Page(s) 2667–2671

Abstract: Background: Flucloxacillin-induced hepatotoxicity is well established in adults. However, there are few paediatric studies of flucloxacillin-induced hepatotoxicity despite this drug being among the most commonly prescribed in children. We aimed to ... ...

Abstract	Background: Flucloxacillin-induced hepatotoxicity is well established in adults. However, there are few paediatric studies of flucloxacillin-induced hepatotoxicity despite this drug being among the most commonly prescribed in children. We aimed to determine the incidence of flucloxacillin-induced hepatotoxicity in children receiving IV therapy as well as identify risk factors for this adverse drug reaction. Methods: We undertook a 2 year retrospective audit of children aged 0-18 years admitted to the Royal Children's Hospital (March 2019 to March 2021) who had liver function tests determined before and after receiving IV flucloxacillin for at least 24 hours duration. Causality was assessed using the Roussel Uclaf Causality Assessment Method and Naranjo criteria. Results: Overall, the incidence of hepatotoxicity was 66/393 (17%). The median age of children with hepatotoxicity was 1.1 years (IQR 0.3-11.9), 43 (65%) received two or more concomitant hepatotoxic medications and 23 (35%) were receiving total parenteral nutrition. The median timing of onset of hepatotoxicity after commencement of flucloxacillin was 4 days (range 2-7). Severe hepatotoxicity (Common Terminology Criteria for Adverse Events grade 3 or above) occurred in 9/66 (14%) for bilirubin, 13/66 (20%) for ALT and 10/66 (15%) for GGT. Predisposing factors for hepatotoxicity were increasing age (OR 1.06 per additional year, 95% CI 1.01-1.10, P = 0.02), with adolescents aged 12-18 years having the highest risk (OR 5.10, 95% CI 2.02-12.85, P = 0.001), and two or more concomitant hepatotoxic medications (OR 2.51, 95% CI 1.02-6.18, P = 0.05). The median time to resolution of hepatotoxicity after cessation of flucloxacillin was 5 days (range 2-10). Conclusions: In children, older patients and those receiving two or more concomitant hepatotoxic medications are at greater risk of flucloxacillin-induced hepatotoxicity.
MeSH term(s)	Adult ; Adolescent ; Humans ; Child ; Infant ; Child, Preschool ; Floxacillin/adverse effects ; Retrospective Studies ; Incidence ; Drug-Related Side Effects and Adverse Reactions ; Risk Factors ; Chemical and Drug Induced Liver Injury/epidemiology ; Chemical and Drug Induced Liver Injury/etiology
Chemical Substances	Floxacillin (43B2M34G2V)
Language	English
Publishing date	2023-09-12
Publishing country	England
Document type	Journal Article
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkad279
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Zs.A 1197: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 124: Show issues

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Article ; Online: Can fosfomycin be used for the treatment of Gram-negative urinary tract infections in children?

Purcell, Rachael / Wang, Nelson / Gwee, Amanda

Archives of disease in childhood

2021 Volume 106, Issue 9, Page(s) 925–928

Language	English
Publishing date	2021-01-18
Publishing country	England
Document type	Journal Article
ZDB-ID	524-1
ISSN	1468-2044 ; 0003-9888 ; 1359-2998
ISSN (online)	1468-2044
ISSN	0003-9888 ; 1359-2998
DOI	10.1136/archdischild-2020-320529
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Um IV Zs.106: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MA 3: Show issues

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Article ; Online: Frequency of drug-induced liver injury in children receiving anti-staphylococcal penicillins.

Tang, Kailey / Coombs, Stefan / Gwee, Amanda

The Journal of antimicrobial chemotherapy

2022 Volume 77, Issue 12, Page(s) 3221–3230

Abstract: Introduction: Anti-staphylococcal penicillins (ASPs) are among the most commonly prescribed antibiotics in children and are associated with a risk of drug-induced liver injury (DILI). Despite the frequent use of ASPs in children, there is no consensus ... ...

Abstract	Introduction: Anti-staphylococcal penicillins (ASPs) are among the most commonly prescribed antibiotics in children and are associated with a risk of drug-induced liver injury (DILI). Despite the frequent use of ASPs in children, there is no consensus on whether liver function tests (LFTs) should be routinely monitored during treatment. Objectives: To review the literature on the frequency of ASP-related DILI in children to determine the incidence, risk factors and outcomes of hepatotoxicity. Methods: PubMed, MEDLINE and Embase were searched in January 2022 for original studies of children who received cloxacillin, dicloxacillin, flucloxacillin, methicillin, nafcillin or oxacillin that included ≥10 children aged up to 18 years, and presented data on the incidence of DILI in children exposed to ASPs. Results: Overall, two studies of oral flucloxacillin, two of intravenous (IV) methicillin, three of IV nafcillin and four of IV oxacillin were included. The mean onset of DILI ranged between 7.0 and 19.0 days following commencement of antibiotic treatment and all episodes resolved between 14.2 and 16.0 days after drug discontinuation, with no specific treatment required. This review found that the incidence of DILI in children was 1 in 50 000 for oral flucloxacillin and ranged from 1 in 3 to 13 for IV oxacillin, methicillin and nafcillin. Conclusions: This review found that routine LFT monitoring is not required in children receiving low dose oral flucloxacillin in a primary care setting, although pharmacovigilance is critical. For IV preparations, the existing data support routine LFT monitoring in those receiving treatment for at least 7 days.
MeSH term(s)	Child ; Humans ; Nafcillin ; Methicillin ; Penicillins/pharmacology ; Floxacillin/adverse effects ; Oxacillin/adverse effects ; Cloxacillin/pharmacology ; Anti-Bacterial Agents/adverse effects ; Chemical and Drug Induced Liver Injury/epidemiology ; Chemical and Drug Induced Liver Injury/etiology
Chemical Substances	Nafcillin (4CNZ27M7RV) ; Methicillin (Q91FH1328A) ; Penicillins ; Floxacillin (43B2M34G2V) ; Oxacillin (UH95VD7V76) ; Cloxacillin (O6X5QGC2VB) ; Anti-Bacterial Agents
Language	English
Publishing date	2022-10-17
Publishing country	England
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkac325
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Zs.A 1197: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 124: Show issues

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Article ; Online: Short Intravenous Antibiotic Courses for Urinary Infections in Young Infants: A Systematic Review.

Hikmat, Samar / Lawrence, Jolie / Gwee, Amanda

Pediatrics

2022 Volume 149, Issue 2

Abstract: Context: Urinary tract infections (UTIs) are common in young infants, yet there is no guidance on the optimal duration of intravenous (IV) treatment.: Objective: To determine if shorter IV antibiotic courses (≤7 days) are appropriate for managing ... ...

Abstract	Context: Urinary tract infections (UTIs) are common in young infants, yet there is no guidance on the optimal duration of intravenous (IV) treatment. Objective: To determine if shorter IV antibiotic courses (≤7 days) are appropriate for managing UTIs in infants aged ≤90 days. Methods: PubMed, the Cochrane Library, Medline, and Embase (February 2021) were used as data sources. Included studies reported original data for infants aged ≤90 days with UTIs, studied short IV antibiotic durations (≤7 days), and described at least 1 treatment outcome. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Studies were screened by 2 investigators, and bias was assessed by using the Newcastle-Ottawa Scale and the Revised Cochrane Risk-of-Bias Tool. Results: Eighteen studies with 16 615 young infants were included. The largest 2 studies on bacteremic UTI found no difference in the rates of 30-day recurrence between those treated with ≤7 vs >7 days of IV antibiotics. For nonbacteremic UTI, there was no significant difference in the adjusted 30-day recurrence between those receiving ≤3 vs >3 days of IV antibiotics in the largest 2 studies identified. Three studies of infants aged ≥30 days used oral antibiotics alone and reported good outcomes, although only 85 infants were ≤90 days old. Conclusions: Shorter IV antibiotic courses of ≤7 days and ≤3 days with early switch to oral antibiotics should be considered in infants aged ≤90 days with bacteremic and nonbacteremic UTI, respectively, after excluding meningitis. Further studies of treatment with oral antibiotics alone are needed in this age group.
MeSH term(s)	Administration, Intravenous/methods ; Anti-Bacterial Agents/administration & dosage ; Drug Administration Schedule ; Humans ; Infant ; Infant, Newborn ; Treatment Outcome ; Urinary Tract Infections/blood ; Urinary Tract Infections/diagnosis ; Urinary Tract Infections/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-01-24
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2021-052466
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Um IV Zs.131: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 357: Show issues

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Article: Persistent pleuritic chest pain in a patient with cystic fibrosis.

Louey, Stefanie / Shanthikumar, Shivanthan / Vandeleur, Moya / Gwee, Amanda / Robinson, Phil

Breathe (Sheffield, England)

2022 Volume 18, Issue 2, Page(s) 220007

Abstract: Pleural effusion is rare in cystic fibrosis. Infection leading to pleural effusion is likely to be polymicrobial, including contributory fungal infection; microbiology of pleural fluid is commonly discordant with sputum. ...

Abstract	Pleural effusion is rare in cystic fibrosis. Infection leading to pleural effusion is likely to be polymicrobial, including contributory fungal infection; microbiology of pleural fluid is commonly discordant with sputum.
Language	English
Publishing date	2022-07-12
Publishing country	England
Document type	Case Reports
ZDB-ID	2562899-9
ISSN	2073-4735 ; 1810-6838
ISSN (online)	2073-4735
ISSN	1810-6838
DOI	10.1183/20734735.0007-2022
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