Neonatal and Pediatric Antimicrobial Stewardship Programs in Europe—Defining the Research Agenda

Abstract

The relationship between suboptimal use of antimicrobials and antimicrobial resistance has become increasingly clear. Despite significant international effort aimed at reducing inappropriate antimicrobial prescribing in hospitals, antimicrobial resistance remains a major public health threat. Antimicrobial Stewardship Programs (ASPs) comprise a series of measures aimed at optimizing the use of antimicrobials, while improving the quality of patient care and promoting cost-effectiveness. This discussion article aims to summarize some of the approaches that have been used in neonatal and pediatric ASPs, with a particular focus on the European healthcare setting. Current evidence demonstrates neonatal and pediatric ASPs to be safe, practical to implement, generally cost-effective and possibly associated with a reduction in antimicrobial resistance rates. This review identified that, despite the recognized need for additional evidence and information on implementation, published data on pediatric ASPs derives mainly from the United States, with very few published reports on formal ASPs in European children's hospitals. Consequently, the optimal method of implementation remains unknown within a European setting. Future research needs to include novel study designs on how best to introduce ASPs, monitoring of clinically relevant outcomes and cost-effectiveness with improved measurement of the impact on antimicrobial resistance.

Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review

“…In contrast to the above, high antibiotic prescriptions are observed in febrile children ( 4 , 5 ). Guidelines, or new diagnostic approaches have shown to effectively reduce antibiotic prescriptions in primary care ( 6 – 9 ).…”

Observational Study of Antibiotic Usage at the Children’s Clinical University Hospital in Riga, Latvia

“…Brett et al focused on ASPs in Europe and they found that these programs were not widely used in pediatrics. For instance, they did not find any publications on ASP studies involving multiple interventions and activities [ 13 ]. It was only in 2012 when Europe had its first European-wide point prevalence survey (PPS) on antibiotic use in hospitalized pediatric patients [ 14 ].…”

Australia-wide Point Prevalence Survey of Antimicrobial Prescribing in Neonatal Units

“…6,7 AMS interventions are increasingly available and have shown promise in delivering improvement in measures of process and outcome. 8,9 Design and implementation of effective and efficient AMS interventions requires data regarding current antimicrobial prescribing patterns, which is relatively scarce for hospitalized neonates. 9 The aims of this study were to describe antimicrobial use in hospitalized Australian neonates, to analyze prescribing appropriateness, and to identify potential targets for quality improvement.…”