A regionwide intervention to promote appropriate antibiotic use in children reversed trends in erythromycin resistance to<i>Streptococcus pyogenes</i>

Gagliotti, Carlo; Buttazzi, Rossella; Mario, Simona Di; Morsillo, Filomena; Moro, Maria Luisa

doi:10.1111/apa.13072

Cited by 11 publications

(29 citation statements)

References 10 publications

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“…Thirty-nine (39/113, 34.5%) were multicentre studies: 43.6% (17/39) were set in the USA, 35.9% (14/39) in Europe, and the rest 20.5% in Asia and Africa (8/39). [52,58,66,67,72,106,112,115,124,137,141] as an outcome used mostly to analyse audit and feedback ASP [58,67,74,141]. In five cases, no changes were reported [58,66,74,106,115], while the other seven studies showed an increased susceptibility of the bacteria analysed [52,67,72,112,124,137,141].…”

Section: Resultsmentioning

confidence: 99%

“…[52,58,66,67,72,106,112,115,124,137,141] as an outcome used mostly to analyse audit and feedback ASP [58,67,74,141]. In five cases, no changes were reported [58,66,74,106,115], while the other seven studies showed an increased susceptibility of the bacteria analysed [52,67,72,112,124,137,141]. The most interesting results were a decrease in extended spectrum beta-lactamase (ESBL) producers E. coli and K. pneumoniae [72,112,124]; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy (DOT) [67,124]; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides [137,141].…”

Section: Resultsmentioning

confidence: 99%

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Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

113

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Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

113

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“…). Concurrently, the antibiotic resistance, assessed through streptococcal pyogenes resistance to macrolides, showed a significant decreasing trend . However, significant differences in antibiotic prescription behaviours still existed between family paediatricians (Fig ), which has been a known phenomenon, even in areas with low antibiotic prescription rates .…”

Section: Discussionmentioning

confidence: 99%

Observational pre–post study showed that a quality improvement project reduced paediatric antibiotic prescribing rates in primary care

et al. 2018

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“…Although erythromycin resistance rates were over 20% in many countries until early 2000s, there are many recent reports of decreasing erythromycin resistance rates. Decline of erythromycin resistance rates might be due either to efforts to reduce usage of macrolides in society [ 4 5 ] or to clonal changes in resistance genotypes [ 6 7 8 9 ]. There are three well-known genotypes representing macrolide resistance: erm (A) for the MLS B (macrolide, lincosamide, and streptogramin B) inducible phenotype, erm (B) for the MLS B constitutive phenotype, and mef (A) for the M phenotype.…”

Section: Antibiotic Resistancementioning

confidence: 99%

“…In comparison with the early 2000s, the erythromycin resistance rate decreased from 13.6% to 2.6% during the late 2000s after introduction of this policy in the region [ 4 ]. A regional intervention to promote appropriate antibiotic use in children reversed trends in erythromycin resistance in Bologna, Italy [ 5 ]. The use of macrolides decreased 24% during the study period from 2007 through 2013.…”

Section: Antibiotic Resistancementioning

confidence: 99%

Optimal Diagnosis and Treatment of Group A Streptococcal Pharyngitis

Kim

2015

Infect Chemother

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A regionwide intervention to promote appropriate antibiotic use in children reversed trends in erythromycin resistance toStreptococcus pyogenes

Cited by 11 publications

References 10 publications

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Observational pre–post study showed that a quality improvement project reduced paediatric antibiotic prescribing rates in primary care

Optimal Diagnosis and Treatment of Group A Streptococcal Pharyngitis

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