Potentially inappropriate prescribing in children

Barry, Emma; Smith, Susan M

doi:10.1093/fampra/cmv091

Cited by 5 publications

(2 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A critical factor associated with MRSA is the quality of prescribed antibiotics, especially considering their spectrum of activity [ 28 ]. Antibiotics are the most frequently prescribed drug in children [ 29 ] with a high rate of inappropriate prescription [ 30 ]. Efforts should focus on decreasing broad-spectrum antibiotic use for common diseases [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and antimicrobial susceptibility of Staphylococcus aureus in children in a tertiary care pediatric hospital in Milan, Italy, 2017—2021

et al. 2022

View full text Add to dashboard Cite

Background Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent worldwide and can cause severe diseases. MRSA is associated with other antibiotic resistance. COVID-19 pandemic increased antimicrobial resistance in adult patients. Only a few data report the antimicrobial susceptibility of S. aureus in the Italian pediatric population, before and during the COVID-19 pandemic. Methods We included all the S. aureus positive samples with an available antibiogram isolated from pediatric patients (< 18 years old) in a tertiary care hospital in Milan, Italy, from January 2017 to December 2021. We collected data on demographics, antimicrobial susceptibility, and clinical history. We compared methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA strains. We calculated the frequency of isolation by year. The incidence of isolates during 2020 was compared with the average year isolation frequency using the univariate Poisson test. We compared the proportion of MRSA isolates during 2020 to the average proportion of other years with the Chi-squared test. Results Our dataset included a total of 255 S. aureus isolated from 226 patients, 120 (53%) males, and 106 (47%) females, with a median age of 3.4 years (IQR 0.8 – 10.5). The mean isolation frequency per year was 51. We observed a significant decrease of isolations during 2020 (p = 0.02), but after adjusting for the total number of hospitalization per year there was no evidence that the incidence changed. Seventy-six (30%) S. aureus were MRSA. Twenty (26%) MRSA vs 23 (13%) MSSA (p = 0.02) were hospital-acquired. MRSA strains showed higher resistance to cotrimoxazole, clindamycin, macrolides, levofloxacin, gentamicin, and tetracyclin than MSSA strains. None of MRSA were resistant to linezolid and vancomycin, one was resistant to daptomycin. The proportion of MRSA did not change during the COVID-19 pandemic. The overall clindamycin resistance was high (17%). Recent antibiotic therapy was related to MRSA infection. Conclusion The proportion of MRSA did not change during the COVID-19 pandemic and remained high. Clindamycin should not be used as an empirical MRSA treatment due to its high resistance.

show abstract

Section: Discussionmentioning

confidence: 99%

Epidemiology and antimicrobial susceptibility of Staphylococcus aureus in children in a tertiary care pediatric hospital in Milan, Italy, 2017—2021

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Almost 50% of children admitted to Australian hospitals are receiving at least one antibiotic at any time, 1 and unnecessarily prolonged intravenous prescriptions are frequently reported. [1][2][3] Switching from intravenous-tooral antibiotics may reduce complications of intravenous therapy and potentially allow children to be discharged home sooner. A key antimicrobial stewardship (AMS) activity is the development of antimicrobial treatment guidelines, including advice on intravenous and oral antibiotics, however, the benefits of these guidelines can only be fully realised with effective implementation.…”

Section: Problemmentioning

confidence: 99%

Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

McMullan

Mahony

Java³

et al. 2021

BMJ Open Qual

View full text Add to dashboard Cite

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

show abstract

The impact of prescription drug co-payments for publicly insured families

Mohan

Nolan

2019

Eur J Health Econ

View full text Add to dashboard Cite

Potentially inappropriate prescribing in children

Cited by 5 publications

References 18 publications

Epidemiology and antimicrobial susceptibility of Staphylococcus aureus in children in a tertiary care pediatric hospital in Milan, Italy, 2017—2021

Epidemiology and antimicrobial susceptibility of Staphylococcus aureus in children in a tertiary care pediatric hospital in Milan, Italy, 2017—2021

Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

The impact of prescription drug co-payments for publicly insured families

Contact Info

Product

Resources

About