Making a Case for Pediatric Antimicrobial Stewardship Programs

Abstract

Although antimicrobials are commonly used in children, it is important to remember that they can have a profound impact on this unique patient population. Inadvertent consequences of antiinfective use in children include antimicrobial resistance, infection caused by Clostridium difficile, increased risk of obesity, and adverse drug events. In addition, compared with adults, children have different dosing requirements, antimicrobial formulation needs, pharmacokinetics, and antimicrobial susceptibility profiles. Therefore, pediatric-specific antimicrobial stewardship efforts are needed to promote appropriate use of antimicrobials in children. The primary purposes of this review article are to provide a rationale behind pediatric-focused antimicrobial stewardship and to describe currently available evidence regarding the initiatives of pediatric antimicrobial stewardship programs (ASPs). A literature search of the Medline database was performed (from inception through March 2015). The studies included in this review focus on antimicrobial stewardship interventions in inpatient pediatric settings. Ten inpatient studies involving pediatric-focused antimicrobial stewardship interventions were identified from the published literature. Four studies used the core strategy of prospective audit with feedback; two used prior approval. The remaining four used supplemental antimicrobial stewardship strategies (guidelines, clinical pathways, and computerized decision support tools). In general, the interventions resulted in decreased antimicrobial use, reduced antimicrobial costs, and fewer prescribing errors. Children have unique medical needs related to antimicrobials and deserve focused ASP efforts. The literature regarding pediatric antimicrobial stewardship interventions is limited, but published interventions may serve as paradigms for developing pediatric ASPs as demonstrated by the general success of these interventions.

Pediatric Antimicrobial Stewardship Programs

“…10 Pediatric-focused ASPs are necessary because of the differences in antimicrobial need and use among this patient population, unique considerations and dosing, vulnerability for resistance due to a lifetime of antibiotic exposure, and the increased risk of adverse events. 12 In June 2016, the Joint Commission released prepublication requirements for the new Antimicrobial Stewardship Standard, which are effective as of January 2017. This standard, which will be part of the medication management standards, provides specifics with regard to elements, including accountability, leadership, education, and core elements, that will be required.…”

Antibiotic Stewardship and Hospital Hygiene in German Paediatric Inpatient Facilities: A Qualitative Survey from the Paed IC Working Group

“…Antibiotic stewardship (ABS) [27,34,46] and hospital hygiene [10,23] have both been identified as key components in clinical practice to increase patient safety in hospital inpatients [44]. The most important aim of ABS is to optimize clinical outcomes of patients with infectious diseases [46].…”

Antimicrobial Stewardship for Newborns in the Neonatal Intensive Care Unit

“…Antibiotics are frequently overprescribed in pediatrics leading to antibiotic resistance, an increase in Clostridium difficile infections, increased adverse drug reactions, and obesity. 2 The NICU represents a unique environment where medically fragile infants frequently are exposed to antibiotics. In a point prevalence study in Europe, 20 to 40% of NICU patients received antibiotics on any given day with up to 90% of patients receiving antibiotics during admission.…”