Multinational consensus antimicrobial stewardship recommendations for children managed in hospital settings

McMullan, Brendan; Bryant, Penelope A; Duffy, Eamon; Bielicki, Julia; Cock, Pieter De; Science, Michelle; Zembles, Tracy N.; Timberlake, Kathryn; Monsees, Elizabeth; Hamdy, Rana F.; Tribble, Alison C.; Newland, Jason G.; Patel, Sanjay

doi:10.1016/s1473-3099(22)00726-5

Cited by 6 publications

(4 citation statements)

References 38 publications

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“…Focusing on the evidence published so far, the best metric for the evaluation of the aggregate consumption of antimicrobials in pediatrics has not yet been defined. Although days of therapy (DOT) seems to be the most currently recommended metric in hospital settings despite its low feasibility [14], other accepted methods are available like prescribed daily doses (PDD), point prevalence surveys (PPS), length of therapy (LOT) or DDD [15][16][17]. D'Amore et al used different metrics to assess the use of antibiotics in hospitalized pediatric patients [18], evaluating DOT, PDD and LOT and comparing PDD with DDD.…”

Section: Discussionmentioning

confidence: 99%

Development of Antimicrobial Defined Daily Dose (DDD) for the Pediatric Population

et al. 2023

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Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improve patient outcomes, and reduce resistance. To assess the effectiveness of ASPs, it is necessary to have indicators that can be widely used. Defined daily dose (DDD) was designed by WHO for the adult population as a consumption indicator. However, there are no DDDs adapted to the pediatric population. The main objective of this study is to establish the most appropriate DDD values in this population. An observational, retrospective, multicenter study was conducted. Antimicrobial prescriptions were collected from pediatric wards of seven Spanish tertiary hospitals for 2 years. The DDDs obtained from the prescriptions were compared with the theoretical DDDs agreed upon in the first stage. To select the optimal DDD, the following were analyzed: power value, magnitude obtained from the differences in the DDD, statistical significance, and degree of agreement in the stipulated doses. A total of 4788 prescriptions were collected. Pediatric DDD was defined for 30 different antimicrobials. A potency >80% was obtained in 24 antibiotics. 51.2% of the selected DDD correspond to Phase I and 39.5% from Phase II. Pediatric DDD of different antimicrobials was obtained, providing an indicator that can be used globally in different hospitals to analyze the consumption and efficacy of ASPs.

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Section: Discussionmentioning

confidence: 99%

Development of Antimicrobial Defined Daily Dose (DDD) for the Pediatric Population

et al. 2023

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“…ABS programs have been more often run in adult patient settings. The specificity of pediatric patients, made of lower total numbers, but also their spreading from primary care to the ICU [ 21 , 22 , 23 ], can make starting an ABS pediatric program more difficult than in the adult population [ 24 ]. Building an ABS pediatric program means also creating a multidisciplinary interprofessional ABS team able to prepare guidelines, monitoring antibiotic prescriptions and defining corrective measures, and the availability of administrative consensus with adequate financial support [ 25 ].…”

Section: What About Antimicrobial Resistance?mentioning

confidence: 99%

Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children

2023

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Antibiotics account for over 10% of the overall drug expense of the National Health System in Italy in 2021. Their use in children is of particular interest on one side, because acute infections are very common in children, while they build their immunologic library of competence; on the other side, although many acute infections are expected and turn out to be of viral origin, caregivers will often ask the family doctor or primary care attending to reassure them by prescribing antibiotic treatment, although it may often be unnecessary. The inappropriate prescription of antibiotics in children may likely be a source not only of undue economic burden for the public health system but also of increasing development of antimicrobial resistance (AMR). Based on those issues, the inappropriate use of antibiotics in children should be avoided to reduce the risks of unnecessary toxicity, increase in health costs, lifelong effects, and selection of resistant organisms causing undue deaths. Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure an optimal use of antimicrobials to improve patient outcomes while limiting the risk of adverse events including AMR. The aim of this paper is to spread some concept of good use of antibiotics for pediatricians or every other physician involved in the choice to prescribe, or not, antibiotics in children. Several actions could be of help in this process, including the following: (1) identify patients with high probability of bacterial infection; (2) collect samples for culture study before starting antibiotic treatment if invasive bacterial infection is suspected; (3) select the appropriate antibiotic molecule based on local resistance and narrow spectrum for the suspected pathogen(s); avoid multi-antibiotic association; prescribe correct dosage; (4) choose the best route of administration (oral vs. parenteral) and the best schedule of administration for every prescription (i.e., multiple administration for beta lactam); (5) schedule clinical and laboratory re-evaluation with the aim to consider therapeutic de-escalation; (6) stop antibiotic administration as soon as possible, avoiding the application of “antibiotic course”.

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“…Children have been neglected in the UK’s national AMR strategy. Yet there are resources that can be drawn on to develop policies that are sensitive to paediatric populations, such as the recent international consensus recommendations on paediatric AMS in hospital settings 17. UK policy makers need to generate a new strategic vision for AMR that recognises the risks to children and redresses the above omissions if we are to slow down the evolution of AMR in children and neonates.…”

Section: A New Visionmentioning

confidence: 99%

The omission of children from the UK’s antimicrobial strategy must be tackled

Channon‐Wells

Patel

2023

BMJ

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Multinational consensus antimicrobial stewardship recommendations for children managed in hospital settings

Cited by 6 publications

References 38 publications

Development of Antimicrobial Defined Daily Dose (DDD) for the Pediatric Population

Development of Antimicrobial Defined Daily Dose (DDD) for the Pediatric Population

Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children

The omission of children from the UK’s antimicrobial strategy must be tackled

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