Antibiotic Use and Stewardship Practices in a Pediatric Community-based Cohort Study in Peru: Shorter Would be Sweeter

Abstract

Background There is a need to evaluate antibiotic use, duration of therapy and stewardship in low- and middle-income countries to guide the development of appropriate stewardship programs that are global in scope and effectively decrease unnecessary antibiotic use. Methods We prospectively collected information on illness occurrence and antibiotic use from a cohort of 303 children. We evaluated the incidence, duration of therapy and appropriateness of antibiotic prescriptions by five main antibiotic prescribers (physicians and nurses, pharmacists, nursing assistants, self-prescriptions and neighbors or family members). Results Ninety percent of children received an antibiotic during follow-up time, and on average, by the end of follow-up a child had spent 4.3% of their first five years of life on antibiotics. The most frequent prescribers were physicians/nurses (79.4%), followed by pharmacists (8.1%), self-prescriptions (6.8%), nursing assistants (3.7%) and family or neighbors (1.9%). Of the 3702 courses of antibiotics prescribed, 30.9% were done so for the occurrence of fever, 25.3% for diarrhea, 2.8% for acute lower respiratory disease, 2.7% for dysentery and 38.2% for an undetermined illness. Courses exceeding the recommended duration were common for the principal diseases for which treatment was initiated, with 27.3% of courses exceeding the recommended length duration, representing a potential reduction in 13.2% of days on which this cohort spent on antibiotics. Conclusion Stewardship programs should target medical personnel for a primary care stewardship program even in a context where antibiotics are available to the public with little or no restrictions and appropriate duration should be emphasized in this training.

Frequency of bystander exposure to antibiotics for enteropathogenic bacteria among young children in low-resource settings

“…These trends align with a previous analysis of antibiotic use overall in this study ( 9 ), and can be explained by higher rates of illness ( 5 , 9 ), more frequent antibiotic treatment of illnesses ( 9 ), and higher prevalence of asymptomatic infections ( 5 ) in the South Asian sites. Variation in treatment frequency is likely due to differences in treatment practices and the availability of antibiotics across regions related to prescription requirements and drug shortages ( 13 – 16 ).…”

The Enterics for Global Health (EFGH) Shigella Surveillance Study in Peru

“…There are additional clinics near the catchment area that provide care to individuals with workers insurance (EsSalud) or insurance plans that are either linked to the military or police, or private for-profit. Private clinics are not a common source of medical care, although pharmacies may act to recommend therapies and treatment [ 25 ].…”

“…While highly resistant isolates of S sonnei are well described in the literature, Peru reported its first 2 cases of infection due to S flexneri expressing the CTX-M–type extended-spectrum β-lactamase in 2013 [ 47 ]. These seemingly inevitable increases in resistance to multiple classes of antimicrobials, coupled with the fact that children aged <5 years in Loreto spend >4% of their lives taking antibiotics, a quarter of which are prescribed for diarrheal illness [ 25 ], underscore the need for vaccination as a means of addressing the burden of shigellosis in the Peruvian Amazon, as well as improved practices in antibiotic use among local health practitioners [ 25 ].…”

Regional Perspective of Antimicrobial Stewardship Programs in Latin American Pediatric Emergency Departments

“…Reports of AS programs and activities in the pediatric population in LA are scarce, and most of the publications related to antibiotic stewardship programs come from the adult population [23,31,50,51]. It is possible that the lack of economic resources with no research infrastructure in Latin American health systems makes the process of reporting and publishing data regarding this topic difficult with some information, such as personal communications or information in non-indexed journals [52].…”

“…A paper by Schiffiano et al reports a follow-up for a group of children in Peru who spent a prolonged time on antibiotics for common diseases, exceeding the recommended duration. On average, these children had spent 4.3% of their first 5 years of life on antibiotics with medical personnel as the main prescribers [23]. In specific illnesses like varicella, the reports of high-rated infectious complications and antimicrobial use with low rates of microbiological isolation suggest antibiotic misuse [20].…”