Antimicrobial stewardship program in pediatric medicine

Abstract

The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs on pediatric healthcare, and challenges of pediatric ASP as seen by the authors.

Prescribing Pattern of Pediatric Cardiologists during Clinical Pharmacist Intervention versus Routine Practice: First Comparative Study in Palestine

“…Implementation of the "Antimicrobial Stewardship Program" in our pediatric cardiology ward in partnership with the clinical pharmacist likely contributed to this aforementioned reduction in antibiotic prescribing from 79.2% before to 60.4% after the clinical pharmacist's intervention. Strict adherence to this program can address antibiotic overuse as documented in several reports (Probst et al, 2021, Bagga et al, 2021. In this regard, incorporating well-trained pharmacists into the healthcare system can contribute to reducing inappropriate antibiotic use and the emergence of antimicrobial-resistant (Sakeena et al, 2018).…”

Factors influencing receipt of an antibiotic prescription among insured patients in Tanzania: a cross-sectional study

“…Indeed, targeting lower-level health facilities with antimicrobial stewardship interventions such clinical education, facility-specific guidelines for common infections, and antibiotic oversight through prospective audit and feedback may decrease antibiotic prescriptions. 48 50 …”

“…Moreover, immune senescence in the elderly causes atypical presentations of infectious disease symptoms such as fever and cough, whereas in children they are more pronounced 46. ASPs should be strengthened in paediatrics so as to decrease antibiotic prescriptions as there is strong evidence supporting such an approach 47 48. Despite the challenges of implementing ASPs in paediatrics, clinical education, caregiver education, updated facility-specific guidelines and prospective audit and feedback are stewardship interventions shown to decrease antibiotic utilisation 49–51…”

“…This observation may be attributed to limited resources in terms of medications and diagnostic capabilities resulting in empirical prescribing of antibiotics. Indeed, targeting lower-level health facilities with antimicrobial stewardship interventions such clinical education, facility-specific guidelines for common infections, and antibiotic oversight through prospective audit and feedback may decrease antibiotic prescriptions 48 50…”

Antimicrobial Resistance: The 'Other' Pandemic!

“…Comprehensive guidelines for setting up AMSP have been published by ICMR and Infectious Disease Society of America [ 42 , 43 ]. Guidelines for setting up a pediatric AMSP have also been published [ 44 ]. The antimicrobial stewardship team is usually led by the clinical microbiologist and an infectious disease specialist or a physician/pediatrician with interest in infectious disease.…”