Antibiotic stewardship in
pediatrics: global heath priority
Aulakh R1
1Dr Roosy Aulakh, Associate Professor of Pediatrics, Government Medical
College, Chandigarh, India
Address for
correspondence: Dr Roosy Aulakh. E-mail: drroosy@gmail.com
Abstract
Multidisciplinary antibiotic stewardship (AS) programs targeting both
inpatient and outpatient antibiotic prescription to children need to be
urgently developed in every country and implemented to tackle this
global antibiotic menace.
Key words:
antibiotic stewardship, Resistance, Pediatrics
There is nothing denying the fact that there has been ever increasing
use and misuse of antibiotics amongst pediatric populations across the
world over the recent years. The implications of such misuse and
overuse of antibiotics are already evident: drug-related adverse
events, increasing antibiotic resistance encountered in clinical
scenarios, the development of Clostridium difficile infection and
alteration in microbiota. The development of new antibiotics suitable
for use in pediatric populations hasn’t been able to keep
pace with this ever increasing antibiotic demand. Antibiotic misuse and
overuse is thus a serious patient safety concern and a global public
health priority. In a recent report by Singh JK et al on antibiotic
susceptibility of bacterial agents in children with Severe Acute
Malnutrition (SAM) from a tertiary care hospital in Madhya Pradesh,
India, most bacterial isolates were found to be resistant to commonly
used antibiotics [1]. These results reinforce urgent need to implement
robust strategies for limiting the emergence of antibiotic-resistant
bacterial strains.
It’s a routine observation to see children being prescribed
antibiotics in outpatient departments in viral illnesses or being
prescribed broad spectrum antibiotics when narrow spectrum would have
been apt. It is becoming a reflex response of residents posted in
pediatric emergencies to start broad spectrum intravenous antibiotics
to almost every patient being admitted in pediatric emergency without a
proper evaluation and work up. Every patient not responding to therapy
is taken as indication of failure of first line antibiotics and
upgradation of antibiotics is followed almost blindly without
considering other factors which could have led to failure of child to
respond to therapy. Upon receiving antibiotic susceptibility pattern on
positive culture reports, de-escalation of antibiotic therapy is rarely
considered. It is high time for each one of us to introspect our policy
of antibiotic drug use and update oneself with latest guidelines for
antibiotic use amongst the vulnerable pediatric population.
There is growing evidence based on the benefits achieved with
implementation of antibiotic stewardship programs in both hospital and
out-patient settings amongst pediatric populations. Agwu et al.
evaluated a World Wide Web-based antimicrobial restriction program at a
175-bed, tertiary care pediatric teaching hospital and reported 11.6 %
reduction in the number of dispensed antibiotic doses leading to
$370,069 reduction in projected annual costs [2]. Di Pentima et al.
reported steady decline in antimicrobial use, expressed as the number
of doses administered per 1,000 patient-days, as measured 3 years
before and 3 years after the implementation of the AS program carried
out in a pediatric teaching hospital in Tennessee, USA [3]. Similar
promising results have been reported with implementation of AS program
in outpatient settings by Gerber et al who reported almost 50% decline
in broad-spectrum antibiotic prescriptions [4].
Despite the concern of increasing bacterial resistance, the situation
is not as dismal. Upadhya K et al have reported high efficacy of
injection crystalline penicillin as first line antibiotic in treating
hospitalized children with community acquired pneumonia [5]. These
results strengthen the claim that rational antibiotic prescriptions can
still be highly efficacious and at the same time benefit in curbing
increasing antibiotic resistance being encountered commonly nowadays.
Multidisciplinary antibiotic stewardship (AS) programs targeting both
inpatient and outpatient antibiotic prescription to children need to be
urgently developed in every country and implemented to tackle this
global antibiotic menace. Clear-cut guidelines for AS need to be framed
which should address most of the queries related to antibiotic use
amongst children: when to start antibiotics, whether to start narrow
spectrum or broad spectrum antibiotic, dosage, route, duration, when to
upgrade to second line or third line antibiotics, and most importantly
when to de-escalate antibiotic therapy. Implementation and maintenance
of AS programs to encourage and maintain judicious use of antibiotics
would require collective effort by all the stake holders,
administrative and financial support along with regular appraisal of
the benefits of ongoing AS program to take a call on its continuation.
Funding:
Nil, Conflict of
interest: Nil
Permission from IRB:
Yes
References
1. Singh JK, Bajaj N, Pattnaik D,
Singh J. Antibiotic susceptibility of bacterial agents in children with
SAM: A single-centre cross-sectional study. Int J Pediatr
Res.2016;3(9):672-677.
2. Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE et al. A
world wide web-based antimicrobial stewardship program improves
efficiency, communication, and user satisfaction and reduces cost in a
tertiary care pediatric medical center. Clin Infect Dis.
2008;47:747–753.
3. Di Pentima MC, Chan S, Hossain J. Benefits of a pediatric
antimicrobial stewardship program at a children's hospital. Pediatrics.
2011;128:1062–1070.
4. Gerber JS, Prasad PA, Fiks AG, Localio AR, Grundmeier RW, Bell LM,
et al. Effect of an outpatient antimicrobial stewardship intervention
on broad-spectrum antibiotic prescribing by primary care pediatricians:
a randomized trial. JAMA. 2013;309:2345–2352.
5. K Udaya, Murteli V.K.B. Outcome of children with community acquired
pneumonia treated with injection crystalline penicillin a prospective
study. Int J Pediatr Res.2016;3(9):657-660.
How to cite this article?
Aulakh R. Antibiotic stewardship in pediatrics: global heath priority.
Int J Pediatr Res.2016;3(9):644-645.doi:10.17511/ijpr.2016.9.01.