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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Antimicrobial stewardship in children: more shadows than lights?

Chiara Tersigni1, Elisabetta Venturini2, Carlotta Montagnani2

  • 1Post graduate school of Paediatrics, Univerity of Florence, Florence, Italy.

Expert Review of Anti-Infective Therapy
|October 31, 2019
PubMed

Insights

Antimicrobial stewardship programmes (ASPs) show promise in pediatric care, improving hospital stay and antibiotic use. However, long-term effects on resistance and cost-effectiveness require further investigation.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Health Services Research

Background:

  • Antimicrobial stewardship programmes (ASPs) are crucial for optimizing antibiotic use in children.
  • Pediatric ASPs aim to improve clinical outcomes, prescribing behavior, and control resistance.
  • Evaluating the cost-effectiveness of pediatric ASPs is essential for resource allocation.

Purpose of the Study:

  • To review the effectiveness of pediatric antimicrobial stewardship programmes.
  • To assess impacts on clinical outcomes, prescribing patterns, and antimicrobial resistance.
  • To evaluate the cost-effectiveness of these interventions in children.

Main Methods:

  • Systematic literature search of Medline, Embase, and Cochrane Library up to September 2018.
  • Inclusion of studies evaluating pediatric antimicrobial stewardship programmes.
  • Analysis of data on clinical outcomes, antibiotic use, resistance, and cost-effectiveness.

Main Results:

  • Studies indicate ASPs can reduce hospital stay and antibiotic days in children.
  • Rapid diagnostics combined with ASPs improve pathogen identification and time to therapy.
  • Improvements may diminish over time; impact on resistance and cost-effectiveness is inconsistent due to study heterogeneity.

Conclusions:

  • Pediatric ASPs demonstrate benefits in specific areas like reduced antibiotic exposure.
  • Evidence is limited by single-center studies and varied designs, hindering definitive conclusions.
  • Further high-quality research is needed, focusing on feasible inpatient and outpatient strategies.

Keywords:
Antibiotic stewardshipantimicrobial resistancechildrenclinical outcomescost-effectiveness

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