Monitoring adherence to guidelines of antibiotic use in pediatric pneumonia: the MAREA study

Abstract

BackgroundChildren are the most vulnerable population exposed to the use of antibiotics often incorrectly prescribed for the treatment of infections really due to viruses rather than to bacteria. We designed the MAREA study which consisted of two different studies: i) a surveillance study to monitor the safety/efficacy of the antibiotics for the treatment of pneumonia (CAP), pharyngotonsillitis and acute otitis media in children younger than 14 yrs old, living in Liguria, North-West Italy and ii) a pre−/post-interventional study to evaluate the appropriateness of antibiotic prescription for the treatment these infections. In this paper, we show only results of the appropriateness study about the antibiotic prescription for the treatment of pneumonia.MethodsPatients included in this study met the following inclusion criteria: i) admission to the Emergency/Inpatient Dpt/outpatient clinic of primary care pediatricians for pneumonia requiring antibiotics, ii) informed written consent. The practice of prescribing antibiotics was evaluated before-and-after a 1 day-educational intervention on International/National recommendations.ResultsGlobal adherence to guidelines was fulfilled in 45%: main reason for discordance was duration (shorter than recommended). Macrolide monotherapy and cephalosporins were highly prescribed; ampicillin/amoxicillin use was limited. 61% of patients received >1 antibiotic; parenteral route was used in 33%. After intervention, i) in all CAP, cephalosporin prescription decreased (−23%) and the inappropriate macrolide prescriptions was halved and, ii) in not hospitalized CAP (notH-CAP), macrolides were prescribed less frequently (−25%) and global adherence to guidelines improved (+39%); and iii) in H-CAP antibiotic choice appropriateness increase.ConclusionPrescribing practices were sufficiently appropriate but widespread preference for multidrug empirical regimens or macrolide in monotherapy deserve closer investigation.

Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

“…However, this might not be valid in the Italian Healthcare System, where each child is assigned to a primary care pediatrician, which is the primary referral for any health-related matters, thus guaranteeing continuity in the patient’s care. Nonetheless, our results align with the literature findings in a similar setting, with a high BS-ATs rate prescribed for LRTI [ 18 , 19 ]. Other key drivers for BS-ATs prescriptions might be represented by the young age and by the lack of pneumococcal vaccination and non-normal laboratory findings [ 20 ].…”

Management of Community-Acquired Pneumonia in Pediatrics: Adherence to Clinical Guidelines

“…Community-acquired pneumonia (CAP) is a highly prevalent infection and remains the first cause of early childhood mortality in developing countries (1)(2)(3). Scientific guidelines were established to optimize and standardize medical care yet, several authors reported discrepancies between recommendations and actual management (4)(5)(6)(7)(8), leading to overuse of antibiotics, a higher resistance rate in community-acquired pathogens (9), and longer hospitalizations (7). This study aims to evaluate our local inpatient practices in children with CAP and to identify clinical parameters likely to influence adherence to guidelines, in order to better understand eventual gaps in our medical approaches.…”

Revisiting childhood pneumonia in low-recourse setting hospitals

“…The treating doctor in Sudan using different regimen like penicillin which is recommended by WHO which is cheap and available, Augmentin, b-lactam inhibitors), (which is more expensive and ceftriaxone which is expensive. the Sudanese experience showed no signi icant difference in recovery rate regardless of the drug [23,[31][32][33]. Finally, many studies recommended zinc sulfate with the antibiotic, regardless of the type will minimized hospital stay [34].…”