Abstract
There is growing attention for antimicrobial stewardship in paediatrics. Currently, little is known about secondary care antibiotic practice. We analysed trends in time with respect to inpatient antibiotic use in a secondary paediatric care setting. Total inpatient antibiotic consumption per year (2010–2015) and antibiotic prescriptions for urinary tract infection (UTI) and lower respiratory tract infection (LRTI) were analysed. Variables were total, antibiotic-specific, and intravenous days of therapy (DOT/100PD) and for UTI/LRTI treatment type, route and duration. Third-generation cephalosporin use decreased (DOT/100PD 11.6 in 2011 vs. 5.1 in 2015; p < 0.001); intravenous antibiotics were prescribed less often (p = 0.06). These findings were confirmed for the specific diseases: third-generation cephalosporin use decreased for both UTI (93% vs. 45%; p = 0.002) and LRTI (14% vs. 6%; p = 0.18); the duration of intravenous therapy decreased (UTI p = 0.02; LRTI p < 0.001). Median LRTI treatment duration was 9.2 days in 2008 and 6.6 in 2015 (p < 0.001); penicillin prescriptions were more narrow in spectrum (p = 0.02).Conclusion: A decrease in third-generation cephalosporin use and intravenous route was identified. LRTI treatment was significantly shorter and more narrow in spectrum. This could be explained by awareness and interventions in the context of antimicrobial stewardship. A decrease in antibiotic use is also feasible and important in non-tertiary paediatric wards.What is Known:• Antimicrobial stewardship programmes are effective in reduction of total and broad-spectrum antibiotic use in tertiary paediatric hospitals• The majority of hospitalised paediatric patients are admitted at general, secondary care wards, often for infectious diseasesWhat is New:• Antimicrobial stewardship interventions in secondary care are also effective in establishing a reduction in broad-spectrum antibiotic use, intravenous route and days on antibiotic therapy
Highlights
Given the emergence of antimicrobial resistance and the impact on morbidity and mortality rates, as well as increased health care costs, appropriate antimicrobial use has become extremely important [11]
Antimicrobial stewardship programmes are effective in reduction of total and broad-spectrum antibiotic use in tertiary paediatric hospitals
Antimicrobial stewardship interventions in secondary care are effective in establishing a reduction in broad-spectrum antibiotic use, intravenous route and days on antibiotic therapy
Summary
Given the emergence of antimicrobial resistance and the impact on morbidity and mortality rates, as well as increased health care costs, appropriate antimicrobial use has become extremely important [11]. Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimise toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial-resistant strains [1]. It involves transparent monitoring of prescription data and use of available expertise and resources [12]. These elements could be accomplished by education, implementation of clinical practice guidelines, antimicrobial order forms, and dose optimization [4, 5]. Many studies have shown antimicrobial stewardship programmes (ASP) to be effective in reducing antibiotic prescribing, without negatively affecting the quality of care and patient mortality [19, 25]
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