Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children
Antibiotics account for over 10% of the overall drug expense of the National Health System in Italy in 2021. Their use in children is of particular interest on one side, because acute infections are very common in children, while they build their immunologic library of competence; on the other side,...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/10/4/740 |
| _version_ | 1797605912778637312 |
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| author | Melodie O. Aricò Enrico Valletta Désirée Caselli |
| author_facet | Melodie O. Aricò Enrico Valletta Désirée Caselli |
| author_sort | Melodie O. Aricò |
| collection | DOAJ |
| description | Antibiotics account for over 10% of the overall drug expense of the National Health System in Italy in 2021. Their use in children is of particular interest on one side, because acute infections are very common in children, while they build their immunologic library of competence; on the other side, although many acute infections are expected and turn out to be of viral origin, caregivers will often ask the family doctor or primary care attending to reassure them by prescribing antibiotic treatment, although it may often be unnecessary. The inappropriate prescription of antibiotics in children may likely be a source not only of undue economic burden for the public health system but also of increasing development of antimicrobial resistance (AMR). Based on those issues, the inappropriate use of antibiotics in children should be avoided to reduce the risks of unnecessary toxicity, increase in health costs, lifelong effects, and selection of resistant organisms causing undue deaths. Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure an optimal use of antimicrobials to improve patient outcomes while limiting the risk of adverse events including AMR. The aim of this paper is to spread some concept of good use of antibiotics for pediatricians or every other physician involved in the choice to prescribe, or not, antibiotics in children. Several actions could be of help in this process, including the following: (1) identify patients with high probability of bacterial infection; (2) collect samples for culture study before starting antibiotic treatment if invasive bacterial infection is suspected; (3) select the appropriate antibiotic molecule based on local resistance and narrow spectrum for the suspected pathogen(s); avoid multi-antibiotic association; prescribe correct dosage; (4) choose the best route of administration (oral vs. parenteral) and the best schedule of administration for every prescription (i.e., multiple administration for beta lactam); (5) schedule clinical and laboratory re-evaluation with the aim to consider therapeutic de-escalation; (6) stop antibiotic administration as soon as possible, avoiding the application of “antibiotic course”. |
| first_indexed | 2024-03-11T05:07:49Z |
| format | Article |
| id | doaj.art-35b509e0d72f4688baeb980ea3b2b3a8 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-11T05:07:49Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-35b509e0d72f4688baeb980ea3b2b3a82023-11-17T18:47:02ZengMDPI AGChildren2227-90672023-04-0110474010.3390/children10040740Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in ChildrenMelodie O. Aricò0Enrico Valletta1Désirée Caselli2 U.O. Pediatria, Ospedale G.B. Morgagni—L. Pierantoni, AUSL Romagna, 47121 Forlì, Italy U.O. Pediatria, Ospedale G.B. Morgagni—L. Pierantoni, AUSL Romagna, 47121 Forlì, Italy U.O.C. Malattie Infettive, Ospedale Pediatrico Giovanni XXIII, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70100 Bari, ItalyAntibiotics account for over 10% of the overall drug expense of the National Health System in Italy in 2021. Their use in children is of particular interest on one side, because acute infections are very common in children, while they build their immunologic library of competence; on the other side, although many acute infections are expected and turn out to be of viral origin, caregivers will often ask the family doctor or primary care attending to reassure them by prescribing antibiotic treatment, although it may often be unnecessary. The inappropriate prescription of antibiotics in children may likely be a source not only of undue economic burden for the public health system but also of increasing development of antimicrobial resistance (AMR). Based on those issues, the inappropriate use of antibiotics in children should be avoided to reduce the risks of unnecessary toxicity, increase in health costs, lifelong effects, and selection of resistant organisms causing undue deaths. Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure an optimal use of antimicrobials to improve patient outcomes while limiting the risk of adverse events including AMR. The aim of this paper is to spread some concept of good use of antibiotics for pediatricians or every other physician involved in the choice to prescribe, or not, antibiotics in children. Several actions could be of help in this process, including the following: (1) identify patients with high probability of bacterial infection; (2) collect samples for culture study before starting antibiotic treatment if invasive bacterial infection is suspected; (3) select the appropriate antibiotic molecule based on local resistance and narrow spectrum for the suspected pathogen(s); avoid multi-antibiotic association; prescribe correct dosage; (4) choose the best route of administration (oral vs. parenteral) and the best schedule of administration for every prescription (i.e., multiple administration for beta lactam); (5) schedule clinical and laboratory re-evaluation with the aim to consider therapeutic de-escalation; (6) stop antibiotic administration as soon as possible, avoiding the application of “antibiotic course”.https://www.mdpi.com/2227-9067/10/4/740stewardshipantibioticsde-escalationantimicrobial resistance |
| spellingShingle | Melodie O. Aricò Enrico Valletta Désirée Caselli Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children Children stewardship antibiotics de-escalation antimicrobial resistance |
| title | Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children |
| title_full | Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children |
| title_fullStr | Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children |
| title_full_unstemmed | Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children |
| title_short | Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children |
| title_sort | appropriate use of antibiotic and principles of antimicrobial stewardship in children |
| topic | stewardship antibiotics de-escalation antimicrobial resistance |
| url | https://www.mdpi.com/2227-9067/10/4/740 |
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