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Prophylactic Antibiotic Use in Pediatric Hospitals Too High, New Study Suggests

In a new international study, a team of European authors says that antibiotic use for preventative purposes is too high in pediatric hospitals, prompting a call for better antibiotic stewardship efforts.

In a new large-scale international study looking at antibiotic prescribing in children, researchers have found that about one-third of hospitalized children are receiving antibiotics preventatively rather than to treat bacterial infections and pediatric hospitals are in need of better antibiotic stewardship programs.

Antibiotic overprescribing and the rising rate of antibiotic-resistant bacteria, which has occurred, in part, due to the overuse of antibiotics, have become pressing issues in the global health community. Today, at least 30% of antibiotics prescriptions are unnecessary, according to a study conducted by the Centers for Disease Control and Prevention (CDC). As a result, the United States has set a goal of reducing half of all unnecessary antibiotic prescriptions by 2020, and more hospitals have implemented antibiotic stewardship programs. Such programs are designed to improve the use of antibiotics, thereby reducing side effects of misuse such as serious adverse reactions, antibiotic-resistant infections, and even death.

In a new study published in the Journal of the Pediatric Infectious Diseases Society, a group of European researchers examined antibiotic prescribing practices in children’s hospitals. The paper’s authors included the Antibiotic Resistance and Prescribing in European Children (ARPEC) Project Group, a partnership of universities and health institutions created to develop a new a surveillance system to track antibiotic use and resistance rates in children in Europe. The survey included 17,693 children at 226 pediatric hospitals in 41 countries, including the United States, from October 1 through November 30, 2012. Each hospital in the study conducted a 1-day point prevalence survey, giving researchers a snapshot of antibiotic prescriptions.

Of all pediatric patients surveyed, 36.7% received antibiotics. Among those 6,818 children, 2,242 (32.9%) received at least 1 antibiotic to prevent a potential bacterial infection rather than to treat an occurring infection. Of the antibiotic prescriptions given prophylactically, 26.6% were given prior to surgery to prevent possible infections (most of which were given for more than 1 day), while 73.4% were given to prevent infections associated with medical diseases. Broad-spectrum antibiotics such as tetracyclines, macrolides, lincosamides, and sulfonamides/trimethoprim made up 51.8% of prescriptions given preventatively overall. There were 2 or more antibiotics prescribed in 36.7% of the cases.

“This pattern and high rate of prophylactic prescribing indicates a clear overuse of antibiotics,” said study author Markus Hufnagel, MD, PhD, of the University of Freiburg in Germany, in a recent statement from the Pediatric Infectious Diseases Society. “Hopefully, our study results will help to raise awareness among health professionals about appropriate prescribing of antibiotics in children.”

The study’s authors note that their findings show a high rate of antibiotic prescriptions that contradict the current recommendations, meant to prevent the development of antibiotic-resistant infections. This includes recommendations which call for the use of narrow-spectrum antibiotics given for shorter durations.

Efforts to improve antibiotic prescribing practices should include reducing overall prophylactic antibiotic prescribing, use of broad-spectrum antibiotics, and the duration of antibiotic use, according to the authors. To meet these goals, Dr. Hugnagel calls for more education for clinicians and better implementation of current guidelines on preventative antibiotic use.