Encouraging rational antibiotic use in childhood pneumonia: a focus on Vietnam and the Western Pacific Region

Abstract

Globally, pneumonia is considered to be the biggest killer of infants and young children (aged <5 years) outside the neonatal period, with the greatest disease burden in low- and middle-income countries. Optimal management of childhood pneumonia is challenging in settings where clinicians have limited information regarding the local pathogen and drug resistance profiles. This frequently results in unnecessary and poorly targeted antibiotic use. Restricting antibiotic use is a global priority, particularly in Asia and the Western Pacific Region where excessive use is driving high rates of antimicrobial resistance. The authors conducted a comprehensive literature review to explore the antibiotic resistance profile of bacteria associated with pneumonia in the Western Pacific Region, with a focus on Vietnam. Current management practices were also considered, along with the diagnostic dilemmas faced by doctors and other factors that increase unnecessary antibiotic use. This review offers some suggestions on how these issues may be addressed.

Antibiotic use in children hospitalised with pneumonia in Central Vietnam

“…Systemic incentives to hospitalise children with non-severe conditions is a major challenge throughout Southeast Asia,4 20 21 with children in China often receiving routine intravenous antibiotics when hospitalised with community-acquired pneumonia 19. This is different to findings from sub-Saharan Africa where most children hospitalised with pneumonia have severe disease 22 23.…”

“…Appropriate antibiotic treatment is a key weapon to reduce deaths in children with bacterial pneumonia 3. However, the inappropriate use of antibiotics contributes to antimicrobial resistance and is associated with multiple adverse effects, including negative impacts on the microbiome and increased healthcare costs 4. Encouraging rational antibiotic prescription is a global priority, particularly in Asia, where childhood pneumonia is a major driver of antibiotic use and where access to antibiotics is largely unrestricted 4 5…”

“…Non-severe pneumonia can be managed as an outpatient with a 5-day course of oral antibiotics 10 12. Despite international recommendations and published evidence to support this approach, broad-spectrum antibiotics continue to be overprescribed,4 13 while unnecessary hospital admission and extended treatment durations impose a huge financial burden on families and healthcare systems 14–16…”

Emerging Antibiotic Resistance in Mycoplasma Microorganisms, Designing Effective and Novel Drugs / Therapeutic Targets: Current Knowledge and Futuristic Prospects

“…Mycoplasmoses has gained importance both due to occurrence of frequent outbreaks, inability to diagnose and difficulty to treat 4,5,6,7,8 . Utilization of inappropriate doses of mycoplasma non specific antibiotics is the routine practice in both medical and veterinary practice 4,9,10 . Continuous use of antibiotics against other microbial pathogens also flares up mycoplasma growth and hence frequent emergence of outbreaks 9,10,11,12 .…”

“…Utilization of inappropriate doses of mycoplasma non specific antibiotics is the routine practice in both medical and veterinary practice 4,9,10 . Continuous use of antibiotics against other microbial pathogens also flares up mycoplasma growth and hence frequent emergence of outbreaks 9,10,11,12 . Lack of prophylactic measures adds to the problem 4,8 .…”