Antibiotic Stewardship Programmes Had a Low Impact on Prescribing for Acute Respiratory Tract Infections in Children

Overview

Journal Acta Paediatr

Specialty Pediatrics

Date 2022 May 1

PMID 35491435

Authors

Matti Korppi

Affiliations

Soon will be listed here.

Abstract

Aim: This mini review summarises the available data on antibiotic stewardship programmes (ASP) for acute respiratory tract infections (ARTI) in paediatric outpatients, particularly the implementation and impact of programmes.

Methods: PubMed was searched from 1 January 2012 to 31 December 2021 for papers with abstracts that used the terms respiratory tract infection, antibiotic, child and guideline. We then saw how many of these included the individual terms impact, implementation or stewardship. After exclusions, we included 10 papers that were published in English on children treated as outpatients for ARTIs. All of these included data on implementing and assessing the impact of ASPs.

Results: The primary care data were mainly from the United States. The ASP programmes did not influence antibiotic prescription rates, but broad-spectrum antibiotics decreased by 43-48%. The emergency department data were mainly from France and the antibiotic prescription rate decreased by 31-35% and the rate for broad-spectrum antibiotics by 63-71%. A nationwide register-based study from France confirmed these results.

Conclusion: ASPs had a low impact on overall antibiotic prescription rates and a modest impact on prescribing broad-spectrum antibiotics. The implementation of ASP protocols needs further development, and more research is necessary on barriers to complying with ASPs.

Citing Articles

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Likopa Z, kivite-Urtane A, Strele I, Pavare J Antibiotics (Basel). 2024; 13(9).

PMID: 39335040 PMC: 11428635. DOI: 10.3390/antibiotics13090867.

Antibiotic stewardship programmes had a low impact on prescribing for acute respiratory tract infections in children.

Korppi M Acta Paediatr. 2022; 111(8):1500-1506.

PMID: 35491435 PMC: 9541683. DOI: 10.1111/apa.16381.

References

Leung A, Hon K, Chu W . Acute bacterial sinusitis in children: an updated review. Drugs Context. 2020; 9. PMC: 7685231. DOI: 10.7573/dic.2020-9-3. View

Liapikou A, Cilloniz C, Palomeque A, Torres T . Emerging antibiotics for community-acquired pneumonia. Expert Opin Emerg Drugs. 2019; 24(4):221-231. DOI: 10.1080/14728214.2019.1685494. View

Mainous 3rd A, Lambourne C, Nietert P . Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial. J Am Med Inform Assoc. 2012; 20(2):317-24. PMC: 3638170. DOI: 10.1136/amiajnl-2011-000701. View

Gerber J, Prasad P, Fiks A, Russell Localio A, Grundmeier R, Bell L . Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA. 2013; 309(22):2345-52. DOI: 10.1001/jama.2013.6287. View

Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M . British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011; 66 Suppl 2:ii1-23. DOI: 10.1136/thoraxjnl-2011-200598. View

Ouldali N, Bellettre X, Milcent K, Guedj R, De Pontual L, Cojocaru B . Impact of Implementing National Guidelines on Antibiotic Prescriptions for Acute Respiratory Tract Infections in Pediatric Emergency Departments: An Interrupted Time Series Analysis. Clin Infect Dis. 2017; 65(9):1469-1476. DOI: 10.1093/cid/cix590. View

Angoulvant F, Pereira M, Perreaux F, Soussan V, Pham L, Trieu T . Impact of unlabeled French antibiotic guidelines on antibiotic prescriptions for acute respiratory tract infections in 7 Pediatric Emergency Departments, 2009-2012. Pediatr Infect Dis J. 2013; 33(3):330-3. DOI: 10.1097/INF.0000000000000125. View

Angoulvant F, Rouault A, Prot-Labarthe S, Boizeau P, Skurnik D, Morin L . Randomized controlled trial of parent therapeutic education on antibiotics to improve parent satisfaction and attitudes in a pediatric emergency department. PLoS One. 2013; 8(9):e75590. PMC: 3784452. DOI: 10.1371/journal.pone.0075590. View

Angoulvant F, Skurnik D, Bellanger H, Abdoul H, Bellettre X, Morin L . Impact of implementing French antibiotic guidelines for acute respiratory-tract infections in a paediatric emergency department, 2005-2009. Eur J Clin Microbiol Infect Dis. 2011; 31(7):1295-303. DOI: 10.1007/s10096-011-1442-4. View

10.

Touboul-Lundgren P, Bruno P, Bailly L, Dunais B, Pradier C . Paediatric antibiotic prescriptions in primary care in the Alpes-Maritimes area of southeastern France between 2008 and 2013. Eur J Clin Microbiol Infect Dis. 2016; 36(3):509-516. DOI: 10.1007/s10096-016-2826-2. View

11.

Suzuki H, Dewez J, Nijman R, Yeung S . Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines. BMJ Open. 2020; 10(5):e035343. PMC: 7228535. DOI: 10.1136/bmjopen-2019-035343. View

12.

Panagakou S, Papaevangelou V, Chadjipanayis A, Syrogiannopoulos G, Theodoridou M, Hadjichristodoulou C . Risk factors of antibiotic misuse for upper respiratory tract infections in children: results from a cross-sectional knowledge-attitude-practice study in Greece. ISRN Pediatr. 2012; 2012:685302. PMC: 3503327. DOI: 10.5402/2012/685302. View

13.

Korppi M . Antibiotic stewardship programmes had a low impact on prescribing for acute respiratory tract infections in children. Acta Paediatr. 2022; 111(8):1500-1506. PMC: 9541683. DOI: 10.1111/apa.16381. View

14.

Aoybamroong N, Kantamalee W, Thadanipon K, Techasaensiri C, Malathum K, Apiwattanakul N . Impact of an Antibiotic Stewardship Program on Antibiotic Prescription for Acute Respiratory Tract Infections in Children: A Prospective Before-After Study. Clin Pediatr (Phila). 2019; 58(11-12):1166-1174. DOI: 10.1177/0009922819870248. View

15.

Trinh N, Bruckner T, Lemaitre M, Chauvin F, Levy C, Chahwakilian P . Association between National Treatment Guidelines for Upper Respiratory Tract Infections and Outpatient Pediatric Antibiotic Use in France: An Interrupted Time-Series Analysis. J Pediatr. 2019; 216:88-94.e4. DOI: 10.1016/j.jpeds.2019.09.017. View

16.

Csonka P, Heikkila P, Koskela S, Palmu S, Lajunen N, Riihijarvi S . Cough and cold medicine prescription rates can be significantly reduced by active intervention. Eur J Pediatr. 2021; 181(4):1531-1539. PMC: 8673918. DOI: 10.1007/s00431-021-04344-0. View

17.

Sykes E, Wu V, Beyea M, Simpson M, Beyea J . Pharyngitis: Approach to diagnosis and treatment. Can Fam Physician. 2020; 66(4):251-257. PMC: 7145142. View

18.

Korppi M . Local healthcare professionals need to work together to implement bronchiolitis guidelines that stop unnecessary tests and treatments. Acta Paediatr. 2022; 111(7):1319-1323. DOI: 10.1111/apa.16322. View

19.

Westerhof L, Dumkow L, Hanrahan T, McPharlin S, Egwuatu N . Outcomes of an ambulatory care pharmacist-led antimicrobial stewardship program within a family medicine resident clinic. Infect Control Hosp Epidemiol. 2020; 42(6):715-721. DOI: 10.1017/ice.2020.1275. View

20.

Bradley J, Byington C, Shah S, Alverson B, Carter E, Harrison C . The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011; 53(7):e25-76. PMC: 7107838. DOI: 10.1093/cid/cir531. View