Antibiotic Stewardship in Pediatrics

Abstract

Antibiotic overuse contributes to antibiotic resistance, which is a threat to public health. Antibiotic stewardship is a practice dedicated to prescribing antibiotics only when necessary and, when antibiotics are considered necessary, promoting use of the appropriate agent(s), dose, duration, and route of therapy to optimize clinical outcomes while minimizing the unintended consequences of antibiotic use. Because there are differences in common infectious conditions, drug-specific considerations, and the evidence surrounding treatment recommendations (eg, first-line therapy, duration of therapy) between children and adults, this statement provides specific guidance for the pediatric population. This policy statement discusses the rationale for inpatient and outpatient antibiotic stewardship programs; essential personnel, infrastructure, and activities required; approaches to evaluating their effectiveness; and gaps in knowledge that require further investigation. Key guidance for both inpatient and outpatient antibiotic stewardship programs are provided.

Antimicrobial Therapy in Pediatric Sepsis: What Is the Best Strategy?

“…Antibiotics are the most prescribed drugs in pediatrics ( 7 ). Since its discovery more than 90 years ago, antibiotics have been widely used for the treatment of infections.…”

“…Especially for patients with shock and end-organ disfunction, the ideal moment for receiving antibiotics is within the first hour of health assistance ( 4 , 5 , 12 , 13 ). However, the indiscriminate use of antibiotics can lead to increased resistance, risk of Clostridioides difficile infection, as well as drug related toxicity (acute kidney injury, diarrhea, cytopenia, skin rash and anaphylaxis) ( 7 , 9 ).…”

“…After considering all these conditions we can also evaluate costs, drug availability, risk of toxicity and side effects ( 7 ).…”

“…class of antibiotics is accompanied by a description of new mechanisms of bacterial resistance to antimicrobials (8). Unfortunately, the process of development of new drugs is long and difficult, and the rate of resistance is constantly increasing (7)(8)(9). It is estimated that, without rational use of antibiotics, in 2050 over 10 million people will die every year due to drug resistant infections (10).…”

Antibiotic‐resistant bacteria: COVID‐19 hasn't made the challenge go away

“…First, distinguishing between community‐level bacterial antibiotic resistance and hospital‐level resistance is important. Multiple sources of data show that community‐level antibiotic resistance is related to consumption of antibiotics in the community, 1,2 especially for viral upper respiratory tract infections in children, 3,4 as well as by the use of antibiotics in raising animals 5 . Widespread availability of antibiotics without medical governance in some countries also contributes significantly to antibiotic resistance.…”