2019 Update on Pediatric Medical Overuse

Money, Nathan M.; Schroeder, Alan R.; Quiñonez, Ricardo; Ho, Timmy; Marin, Jennifer R.; Morgan, Daniel J.; Dhruva, Sanket S.; Coon, Eric R.

doi:10.1001/jamapediatrics.2019.5849

Cited by 16 publications

(11 citation statements)

References 73 publications

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“…Clinical characteristics alone are insufficient for correctly diagnosing the aetiology of infectious diseases, particularly in children [5]. This diagnostic uncertainty leads to antibiotic overuse [6][7][8], as well as underuse, i.e. withheld or delayed prescription when an antibiotic is warranted [9].…”

Section: Introductionmentioning

confidence: 99%

A host signature based on TRAIL, IP-10, and CRP for reducing antibiotic overuse in children by differentiating bacterial from viral infections: a prospective, multicentre cohort study

Papan

Argentiero

Porwoll

et al. 2022

Clinical Microbiology and Infection

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Section: Introductionmentioning

confidence: 99%

A host signature based on TRAIL, IP-10, and CRP for reducing antibiotic overuse in children by differentiating bacterial from viral infections: a prospective, multicentre cohort study

Papan

Argentiero

Porwoll

et al. 2022

Clinical Microbiology and Infection

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“…The majority of the recommendations is focused on the newborn patient population and reflects a growing understanding of the impacts of overuse in this patient population in whom screening for rare outcomes can lead to overdiagnosis and overtreatment. [99][100][101] The inclusion of these recommendations also reflects the engagement of a broad group of stakeholders in the PHM community and Delphi panel, including those who primarily practice in a neonatal care environment.…”

Section: Discussionmentioning

confidence: 99%

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value

Tchou

Schondelmeyer

Álvarez

et al. 2021

Hospital Pediatrics

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OBJECTIVES The health care system faces ongoing challenges due to low-value care. Building on the first pediatric hospital medicine contribution to the American Board of Internal Medicine Foundation Choosing Wisely Campaign, a working group was convened to identify additional priorities for improving health care value for hospitalized children. METHODS A study team composed of nominees from national pediatric medical professional societies was convened, including pediatric hospitalists with expertise in clinical care, hospital leadership, and research. The study team surveyed national pediatric hospitalist LISTSERVs for suggestions, condensed similar responses, and performed a literature search of articles published in the previous 10 years. Using a modified Delphi process, the team completed a series of structured ratings of feasibility and validity and facilitated group discussion. The sum of final mean validity and feasibility scores was used to identify the 5 highest priority recommendations. RESULTS Two hundred seven respondents suggested 397 preliminary recommendations, yielding 74 unique recommendations that underwent evidence review and rating. The 5 highest-scoring recommendations had a focus on the following aspects of hospital care: (1) length of intravenous antibiotic therapy before transition to oral antibiotics, (2) length of stay for febrile infants evaluated for serious bacterial infection, (3) phototherapy for neonatal hyperbilirubinemia, (4) antibiotic therapy for community-acquired pneumonia, and (5) initiation of intravenous antibiotics in infants with maternal risk factors for sepsis. CONCLUSIONS We propose that pediatric hospitalists can use this list to prioritize quality improvement and scholarly work focused on improving the value and quality of patient care for hospitalized children.

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“…While antibiotics can be a lifesaving treatment for children with bacterial infections, overuse has become a concern [ 24 , 25 ]. Treatment choices are not always led by evidence-based decisions [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

The integrated management of childhood illness (IMCI) and its potential to reduce the misuse of antibiotics

Carai

Kuttumuratova

Boderscova³

et al. 2021

J Glob Health

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Background The Strategy of the Integrated Management of Childhood Illness (IMCI) was introduced in Central Asia and Europe to address the absence of evidence-based guidelines, the misuse of antibiotics, polypharmacy and over-hospitalization of children. A study carried out in 16 countries analysed the status and strengths of as well as the barriers to IMCI implementation and investigated how different health systems affect the problems IMCI aims to address. Here we present findings in relation to IMCI’s effects on the rational use of drugs, particularly the improved rational use of antibiotics in children, the mechanisms through which these were achieved as well as counteracting system factors. Methods 220 key informants were interviewed ranging from 5 to 37 per country (median 12). Data was analysed for arising themes and peer-reviewed. Results The implementation of IMCI led to improved prescribing patterns immediately after training of health workers according to key informants. IMCI provides standard treatment guidelines and an algorithmic diagnostic- and treatment-decision-tool for consistent decision-making. Doctors reported feeling empowered by the training to counsel parents and address their expectations and desire for invasive treatments and the use of multiple drugs. Improved prescribing patterns were not sustained over time but counteracted by factors such as: doctors prescribing antibiotics to create additional revenues or other benefits; aggressive marketing by pharmaceutical companies; parents pressuring doctors to prescribe antibiotics; and access to drugs without prescriptions. Conclusions Future efforts to improve child health outcomes must include: (1) the continued support to improve health worker performance to enable them to adhere to evidence-based treatment guidelines, (2) patient and parent education, (3) improved reimbursement schemes and prescription regulations and their consistent enforcement and (4) the integration of point–of-care tests differentiating between viral and bacterial infection into standards of care. Pre-requisites will be sufficient remuneration of health workers, sound training, improved health literacy among parents, conducive laws and regulations and reimbursement systems with adequate checks and balances to ensure the best possible care.

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2019 Update on Pediatric Medical Overuse

Cited by 16 publications

References 73 publications

A host signature based on TRAIL, IP-10, and CRP for reducing antibiotic overuse in children by differentiating bacterial from viral infections: a prospective, multicentre cohort study

A host signature based on TRAIL, IP-10, and CRP for reducing antibiotic overuse in children by differentiating bacterial from viral infections: a prospective, multicentre cohort study

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value

The integrated management of childhood illness (IMCI) and its potential to reduce the misuse of antibiotics

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