Antibiotic Prescriptions and Prophylaxis in Italian Children. Is It Time to Change? Data from the ARPEC Project

Abstract

BackgroundAntimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children’s hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions.MethodsA 1-day PPS on antibiotic use in hospitalized neonates and children was performed in Italy between October and December 2012 as part of the Antibiotic Resistance and Prescribing in European Children project (ARPEC). Seven institutions in seven Italian cities were involved. The survey included all admitted patients less than 18 years of age present in the ward at 8:00 am on the day of the survey, who had at least one on-going antibiotic prescription. For all patients data about age, weight, underlying disease, antimicrobial agent, dose and indication for treatment were collected.ResultsThe PPS was performed in 61 wards within 7 Italian institutions. A total of 899 patients were eligible and 349 (38.9%) had an on-going prescription for one or more antibiotics, with variable rates among the hospitals (25.7% - 53.8%). We describe antibiotic prescriptions separately in neonates (<30 days old) and children (> = 30 days to <18 years old). In the neonatal cohort, 62.8% received antibiotics for prophylaxis and only 37.2% on those on antibiotics were treated for infection. Penicillins and aminoglycosides were the most prescribed antibiotic classes. In the paediatric cohort, 64.4% of patients were receiving antibiotics for treatment of infections and 35.5% for prophylaxis. Third generation cephalosporins and penicillin plus inhibitors were the top two antibiotic classes. The main reason for prescribing antibiotic therapy in children was lower respiratory tract infections (LRTI), followed by febrile neutropenia/fever in oncologic patients, while, in neonates, sepsis was the most common indication for treatment. Focusing on prescriptions for LRTI, 43.3% of patients were treated with 3rd generation cephalosporins, followed by macrolides (26.9%), quinolones (16.4%) and carbapenems (14.9%) and 50.1% of LRTI cases were receiving more than one antibiotic. For neutropenic fever/fever in oncologic patients, the preferred antibiotics were penicillins with inhibitors (47.8%), followed by carbapenems (34.8%), aminoglycosides (26.1%) and glycopeptides (26.1%). Overall, the 60.9% of patients were treated with a combination therapy.ConclusionsOur study provides insight on the Italian situation in terms of antibiotic prescriptions in hospitalized neonates and children. An over-use of third generation cephalosporins both for prophylaxis and treatment was the most worrisome finding. A misuse and abuse of carbapenems and quinolones was also noted. Antibiotic stewardship p...

Point Prevalence Survey of Antimicrobial Prescription and Infection in Pediatric and Neonatal wards of Two Iranian Teaching Hospitals

“…The patients were treated mostly with ceftriaxone (35.3%), clindamycin (15.7%), vancomycin (11.8%), meropenem (9.8%), and azithromycin (7.8%). This finding is consistent with that found in European countries, which reported LRTI as a common cause of inappropriate antibiotic prescription (6,34). In comparison, the prescription rates were significantly higher for vancomycin and clindamycin and significantly lower for macrolides in our hospitals (6).…”

“…• Judicious use of inflammatory markers such as procalcitonin for differentiation of bacterial and viral diseases (44) • Implementation of annual PPS programs as a useful, simple, and cheap way for quality assessment and finding targets for improvement in hospitals at national levels (6) Our study has several limitations. First, the study could not assess the duration of antibiotic therapy.…”

“…In a large study from the United States, 60% of children received at least one antibiotic agent during their hospitalization (4). In wide point prevalence surveys (PPSs) in Australia and Italy, 46% and 37.2% of neonates, respectively, received at least one antimicrobial prescription (5,6). Overall, the frequency of antibiotic use in pediatric and neonatal wards was significantly higher in non-European (43.8% and 39.4%) than in European hospitals (35.4% and 21.8%) (7).…”

Antibiotics prescription pattern and compliance for common childhood illnesses – an observational study

“…This study has shown that 73% of children who seek health care are prescribed antibiotics. Although this is less than over 80% reported by some investigators, it is higher than that observed in some studies, where the antibiotic prescription rates range from 35% to 65% [12][13][14]. [17,18].…”

The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands

“…ASPs are commonly focused on in-hospital therapeutic and perioperative prophylactic antimicrobial use [4]. However, up to 90% of antimicrobial use occurs in the outpatient setting, of which, next to family practice, internal medicine and paediatrics are the largest contributors [5,6]. Available studies evaluating outpatient antibiotic use addressed therapeutic antimicrobial use in the ambulatory setting in general, of which 30-50% was inappropriately prescribed [7][8][9].…”