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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
Summary
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.
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