Potential for More Rational Use of Antibiotics in Hospitalized Children in a Country With Low Resistance

Thaulow, Christian; Berild, Dag; Eriksen, Beate Horsberg; Myklebust, Tor Åge; Blix, Hege Salvesen

doi:10.1097/inf.0000000000002106

Cited by 15 publications

(23 citation statements)

References 24 publications

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“…There are no established similar principles for antibiotic consumption analysis in Latvian hospitals, and almost all consumption studies are voluntary and based on researcher enthusiasm. Nevertheless, this is also a problem in many other countries [ 31 , 32 ]. At the moment hospitals in Latvia can choose to conduct or not to conduct antibiotic consumption studies, as well as what methodologies to use.…”

Section: Discussionmentioning

confidence: 99%

Observational Study of Antibiotic Usage at the Children’s Clinical University Hospital in Riga, Latvia

Sviestiņa

Mozgis

2018

Medicina

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Background and objectives: Many pediatric patients have been treated with antibiotics during their hospitalization. There is a need to improve antibiotic prescribing for pediatric patients because many of these prescriptions are inappropriate. Antibiotic consumption analysis was conducted at the Children’s Clinical University Hospital to identify targets for quality improvement. Materials and Methods: A one day cross-sectional point prevalence survey (PPS) was conducted in May and November 2011–2013 using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antibiotic treatment on the day of survey. Total consumption of systemic antibiotics belonging to the ATC J01 class (except amphenicols (J01B) and a combination of antibacterials (J01R)) was also analyzed by using a defined daily dose (DDD) approach and antibiotic drug utilization (90%DU) for the period 2006–2015. Results were compared with results in 2017 using the DDD and 90%DU methodology. Results: The most commonly used antibiotic group in all PPS, except in May and November 2011, was other β-lactam antibiotics (J01D): 42 (40%) prescriptions in May 2013 and 66 (42%) and November 2011. In 2006–2015 and also in 2017, the most commonly used antibiotic groups were penicillins (J01C) and other β-lactam antibiotics (J01D)—76% (90%DU) of the total antibiotic consumption registered in 2006, 73% in 2015 and 70% in 2017. Starting in 2008, amoxicillin was the most commonly used antibiotic at the hospital. The usage of ceftriaxone increased from 3% in 2006 to 13% in 2015, but decreased in 2017 (7%). Conclusions: Study results from 2006–2015 showed that there was a need to establish a stronger antibiotic prescribing policy in the hospital reducing the use of broad-spectrum antibiotics (especially 3rd generation cephalosporins) and increasing the use of narrower spectrum antibiotics. It was partly achieved in 2017 with some reduction in ceftriaxone use.

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Section: Discussionmentioning

confidence: 99%

Observational Study of Antibiotic Usage at the Children’s Clinical University Hospital in Riga, Latvia

Sviestiņa

Mozgis

2018

Medicina

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“…A registry-based population study from Norway (2009–2011) showed that half of term-infants receiving antibiotics were not proven to have a bacterial infection (11). Use of BSA in Norwegian neonates is lower than in older children, but empirical choices of antibiotics vary, and there is a lack of evidence on neonatal dose regimes (15, 16).…”

Section: Introductionmentioning

confidence: 99%

Can We Optimize Antibiotic Use in Norwegian Neonates? A Prospective Comparison Between a University Hospital and a District Hospital

et al. 2019

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Background: Worldwide, a large proportion of neonates are prescribed antibiotics without having infections leading to increased antimicrobial resistance, disturbance of the evolving microbiota, and increasing the risk of various chronical diseases. Comparing practice between different hospitals/settings is important in order to optimize antibiotic stewardship.Aim: To investigate and compare the potential for improved antibiotic stewardship in neonates in two Norwegian hospitals with different academic culture, with emphasis on antibiotic exposure in unconfirmed infections, treatment length/doses, CRP values and the use of broad-spectrum antibiotics (BSA). All types of infections were investigated, but the main focus was on early-onset sepsis (EOS).Methods: We conducted a prospective observational cohort study of antibiotic use in a Norwegian university hospital (UH) and a district hospital (DH), 2017. Unconfirmed infections were defined as culture negative infections that neither fulfilled the criteria for clinical infection (clinical symptoms, maximum CRP >30 mg/L, and treatment for at least 5 days).Results: Ninety-five neonates at the DH and 89 neonates at the UH treated with systemic antibiotics were included in the study. In total, 685 prescriptions (daily doses) of antibiotics were given at the DH and 903 at the UH. Among term and premature infants (≥ 28 weeks), 82% (75% at the UH and 86% at the DH, p = 0.172) of the treatments for suspected EOS were for unconfirmed infections, and average treatment length in unconfirmed infections was 3.1 days (both hospitals). Median dose for aminoglycoside was higher for term infants at the UH (5.96, 95% CI 5.02–6.89) compared to the DH (4.98, 95% CI 4.82–5.14; p < 0.001). At the UH, all prescriptions with aminoglycosides were gentamicin, while tobramycin accounted for 93% of all prescriptions with aminoglycosides at the DH.Conclusion: There is a potential for reduction in both antibiotic exposure and treatment length in these two neonatal units, and a systematic risk/observational algorithm of sepsis should be considered in both hospitals. We revealed no major differences between the UH and DH, but doses and choice of aminoglycosides varied significantly.

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“…This proportion is slightly lower than the results of a one-day PPS performed by another group on antibiotic treatment of hospitalized children across nine provinces in China (67.76%) [ 16 ] but much higher than the rate of antibiotic prescription in a tertiary children’s hospital surveyed in Sichuan, China (46.1%) [ 17 ]. Compared with Western countries (Sweden 35.5% [ 18 ], Norway 24% [ 19 ], UK 40.9% [ 20 ], Italy 38.9% [ 21 ]), our study revealed a much higher rate of antibiotic use in China indicating that the use of antibiotics in the treatment of hospitalized children varies by countries and regions. Thus, there is a need to collect and analyze data regarding the use of antibiotics in local regions and even individual hospitals in order to tailor pediatric antibiotic management more effectively.…”

Section: Discussionmentioning

confidence: 66%

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys

Gao

Guo

et al. 2020

BMC Infect Dis

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Background Misuse and overuse of antibiotics by physicians in the treatment of children is common in China. This study aimed to reveal the overall use of antibiotics to treat children hospitalized in four types of pediatric wards. Methods Seven independent point prevalence surveys (PPSs) were conducted in Shanghai Children’s Hospital of Shanghai Jiao Tong University over the period 2012 to 2018. Pediatric ward types were defined general pediatric medical, pediatric surgical, pediatric intensive care units (PICU), and neonatal. Results A total of 3975 pediatric patients were included in the study, of which 63.9% received at least one dose antibiotic. The top five classes of antibiotics administered were cephalosporins (43.8%, n = 1743), penicillins (13.2%, n = 526), carbapenems (8.7%, n = 347), nitroimidazoles (7.1%, n = 281) and macrolides (6.5%, n = 257). The five most commonly used generic antibiotics were cefuroxime (14.9%, n = 594), ceftriaxone (9.7%, n = 387), cefotaxime (9.0%, n = 358), meropenem (8.1%, n = 320) and ampicillin/sulbactam (6.0%, n = 239). Meropenem was among top five antibiotics prescribed in the general pediatric, PICU and neonatal wards and sixth in the pediatric surgical wards. Of all children on antibiotics, 23.4% received prophylactic treatment, and prophylaxis accounted for 68.1% of indications for treatment in the pediatric surgical wards. Conclusions Given that over-treatment with third-generation cephalosporins and carbapenems has been associated with treatment-resistant infections, the prescription of these drugs should be strictly controlled and monitored, and measures should be taken to improve the management of surgical prophylaxis in hospitalized children in China.

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Potential for More Rational Use of Antibiotics in Hospitalized Children in a Country With Low Resistance

Abstract: This study reveals an excess of prescriptions with BSA in relation to the low resistance rate in Norway. Our findings reveal areas for improvement that can be useful in the forthcoming antibiotic stewardship programs in Norwegian pediatric departments.

Cited by 15 publications

References 24 publications

Observational Study of Antibiotic Usage at the Children’s Clinical University Hospital in Riga, Latvia

Observational Study of Antibiotic Usage at the Children’s Clinical University Hospital in Riga, Latvia

Can We Optimize Antibiotic Use in Norwegian Neonates? A Prospective Comparison Between a University Hospital and a District Hospital

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys

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