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Rational prescribing of antibacterials in hospitalised children
1Section of Bacteriology, University Children's Hospital, Eberhard Karl University, Tübingen, Germany.
Insights
This review explores cost-effective antimicrobial prescribing for serious pediatric infections. It highlights the need for more research on rational treatment strategies and newer therapies in children.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacoeconomics
- Antimicrobial Stewardship
Background:
- Serious community-acquired infections in hospitalized infants and children require effective antimicrobial therapy.
- Current pediatric studies on cost-containment strategies for antimicrobial use are limited.
- Optimizing antimicrobial prescribing in pediatric populations is crucial for both clinical outcomes and healthcare costs.
Purpose of the Study:
- To review rational antimicrobial prescribing for serious pediatric infections.
- To evaluate cost-containment strategies in pediatric antimicrobial therapy.
- To propose evidence-based treatment strategies for specific serious bacterial infections in children.
Main Methods:
- Literature review of antimicrobial agents and cost-containment strategies.
- Discussion of specific pediatric considerations for parenteral antibacterials.
- Analysis of rational treatment approaches for serious pediatric bacterial infections.
Main Results:
- Limited pediatric data exists for strategies like streamlined therapy, outpatient parenteral therapy, and sequential therapy.
- Specific parenteral antimicrobial choices (penicillins, cephalosporins, aminoglycosides, macrolides) for pediatric use are discussed.
- Rational treatment strategies are proposed for meningitis, occult bacteremia, endocarditis, osteomyelitis, arthritis, pyelonephritis, Lyme borreliosis, and pneumonia.
Conclusions:
- There is significant potential for cost reduction in treating serious pediatric infections.
- Further comparative studies are urgently needed to validate newer antimicrobial strategies against traditional regimens in children.
Abstract:
The subject of this review is the rational prescribing of antimicrobial agents for the therapy of serious community-acquired infections in hospitalised infants and children. First, cost-containment strategies such as streamlining of antibacterial therapy, outpatient parenteral antibacterial therapy and sequential ('stepdown') therapy with parenteral followed by oral therapy are reviewed. In most of these areas, paediatric studies are scant or lacking. Then specific paediatric aspects of the choice of parenteral antibacterials such as penicillins, cephalosporins, aminoglycosides, macrolides and other agents are discussed. With particular reference to cost containment, rational treatment strategies for some serious bacterial infections such as meningitis, occult bacteraemia, endocarditis, osteomyelitis, arthritis, pyelonephritis, Lyme borreliosis (advanced stages) and pneumonia are proposed. In most of these disease, there is potential for cutting treatment costs and studies that compare these newer strategies with traditional treatment regimens are urgently needed.