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Pediatric Antibiotic Prescribing in China According to the 2019 World Health Organization Access, Watch, and Reserve
Chu-Ning Wang1, Benedikt D Huttner2, Nicola Magrini3
1Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.
Insights
Overuse of WHO Watch antibiotics in Chinese pediatric care is common, particularly for respiratory conditions. Strengthening antimicrobial stewardship using AWaRe metrics is crucial for appropriate pediatric antibiotic prescribing.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic prescribing patterns in pediatric practice are critical for combating antimicrobial resistance.
- The World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) metrics provide a framework for optimizing antibiotic use.
- Understanding clinical indication-specific antibiotic prescribing is essential for identifying areas of overuse and misuse.
Purpose of the Study:
- To evaluate antibiotic prescribing in Chinese pediatric settings based on WHO AWaRe metrics.
- To identify specific clinical indications and antibiotic classes associated with potential problems in pediatric antibiotic use.
- To inform strategies for improving antimicrobial stewardship in pediatric care.
Main Methods:
- Analysis of pediatric prescription records from 16 tertiary care hospitals in China during 2018.
- Inclusion of outpatient and emergency department encounters, with data sampled monthly.
- Categorization of antibiotic prescribing according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) classification.
Main Results:
- Antibiotics were prescribed in 36.3% of 260,001 pediatric encounters.
- WHO Watch group antibiotics constituted 82.2% of all antibiotic therapies.
- Respiratory tract conditions accounted for 70.0% of antibiotic prescriptions, with bronchitis/bronchiolitis, upper respiratory tract infections, and pneumonia being the most frequent indications.
Conclusions:
- Significant overuse and misuse of WHO Watch group antibiotics were observed in pediatric outpatients, especially for respiratory and viral infections.
- There is a need to enhance pediatric antimicrobial stewardship programs in China.
- Implementation of WHO AWaRe metrics can guide more rational antibiotic prescribing in pediatric populations.
Objectives:
To assess clinical indication-specific antibiotic prescribing in pediatric practice in China based on the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) metrics and to detect potential problem areas.
Study Design:
Pediatric prescription records on the 16th of each month during 2018 were sampled for all encounters at outpatient and emergency departments of 16 tertiary care hospitals via hospital information systems. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) classification.
Results:
A total of 260 001 pediatric encounters were assessed, and antibiotics were prescribed in 94 453 (36.3%). In 35 167 encounters (37.2%), at least 1 intravenous antibiotic was administered. WHO Watch group antibiotics accounted for 82.2% (n = 84 176) of all antibiotic therapies. Azithromycin (n = 15 791; 15.4%) was the most commonly prescribed antibiotic, and third-generation cephalosporins (n = 44 387; 43.3%) were the most commonly prescribed antibiotic class. In at least 66 098 encounters (70.0%), antibiotics were prescribed for respiratory tract conditions, mainly for bronchitis/bronchiolitis (n = 25 815; 27.3%), upper respiratory tract infection (n = 25 184; 26.7%), and pneumonia (n = 13 392; 14.2%).
Conclusions:
Overuse and misuse of WHO Watch group antibiotics for respiratory tract conditions and viral infectious diseases is common in pediatric outpatients in China. Pediatric antimicrobial stewardship should be strengthened using WHO AWaRe metrics.
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