Abstract
The prevalence of antimicrobial resistance in India is among the highest in the world. Antimicrobial use in inpatient settings is an important driver of resistance, but is poorly characterized, particularly in hospitalized children. In this study, conducted as part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) project, we examined the prevalence of and indications of antimicrobial use, as well as antimicrobial agents used among hospitalized children by conducting four point prevalence surveys in six hospitals between February 2016 and February 2017. A total of 681 children were hospitalized in six hospitals across all survey days, and 419 (61.5%) were prescribed one or more antimicrobials (antibacterials, antivirals, antifungals). Antibacterial agents accounted for 90.8% (547/602) of the total antimicrobial prescriptions, of which third-generation cephalosporins (3GCs) accounted for 38.9% (213/547) and penicillin plus enzyme inhibitor combinations accounted for 14.4% (79/547). Lower respiratory tract infection (LRTI) was the most common indication for prescribing antimicrobials (149 prescriptions; 24.8%). Although national guidelines recommend the use of penicillin and combinations as first-line agents for LRTI, 3GCs were the most commonly prescribed antibacterial agents (55/149 LRTI prescriptions; 36.9%). In conclusion, 61.5% of hospitalized children were on at least one antimicrobial agent, with excessive use of 3GCs. Hence there is an opportunity to limit their inappropriate use.
Highlights
Antimicrobial resistance is rising across the globe, with prevalence in India reported as being among the highest [1,2]
point prevalence surveys (PPSs) were conducted in the neonatal intensive care units and neonatal wards of all eight hospitals and the pediatric units of only six hospitals
For Lower respiratory tract infection (LRTI), involving 226 hospitals from 41 countries, the overall percentage of hospitalized children on third-generation cephalosporins were mainly used as monotherapy (38/55) and in combination in antimicrobials was 42.5%, which was much lower than the 61.5% in our study [8]
Summary
Antimicrobial resistance is rising across the globe, with prevalence in India reported as being among the highest [1,2]. Information on antimicrobial use from point prevalence surveys (PPSs) could be used to design, implement, and assess the effects of antimicrobial policies [6]. Only one multicenter (>2 hospitals) study describing antimicrobial use among hospitalized children has been published in India [7]. This study did not collect information on the total number of children admitted to various wards and could not estimate the rate of antimicrobial use per patient. We examined the prevalence of and indications of antimicrobial use, as well as the antimicrobial agents used among hospitalized children, by conducting four PPSs in six hospitals in India
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