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Characteristics and Management of Children With Suspected COVID-19 Admitted to Hospitals in India: Implications for
Santosh Kumar1, Mainul Haque2, Arvind Shetty3
1Periodontology and Implantology, Karnavati University, Gandhinagar, IND.
Insights
Pediatric COVID-19 management in India shows high antibiotic and other antimicrobial use, despite most children recovering. Stewardship programs are needed to address imprudent prescribing practices.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- COVID-19 management
Background:
- Growing concern over antimicrobial overuse in pediatric COVID-19 patients, particularly in developing nations.
- Need for improved guidelines to manage children with COVID-19 and address imprudent prescribing of antibiotics, antivirals, and antimalarials.
Purpose of the Study:
- To document the current management of pediatric COVID-19 cases across India.
- To assess antimicrobial prescribing patterns, guideline adherence, and mortality rates.
Main Methods:
- A point prevalence study was conducted across 30 hospitals in India.
- Data collected using specially developed report forms.
Main Results:
- Most admitted children (70%) were aged 11-18 years; 65.8% were boys.
- Antibiotics were prescribed empirically to 75.3% of children, with 76.7% on the Watch list.
- Significant use of antimalarials (21.4%), antivirals (15.2%), and antiparasitics (27.2%) was observed, irrespective of guideline adherence.
Conclusions:
- While most children recovered (92.2%), high rates of empiric antibiotic use and broad-spectrum antimicrobial prescribing are concerning.
- The study highlights the need for targeted antimicrobial stewardship programs to optimize treatment and reduce resistance.
Introduction:
There is a growing focus on researching the management of children with COVID-19 admitted to hospital, especially among developing countries with new variants alongside concerns with the overuse of antibiotics. Patient care can be improved with guidelines, but concerns with the continued imprudent prescribing of antimicrobials, including antibiotics, antivirals, and antimalarials.
Objective:
Consequently, a need to document the current management of children with COVID-19 across India. Key outcome measures included the percentage of prescribed antimicrobials, adherence to current guidelines, and mortality.
Methodology:
A point prevalence study using specially developed report forms among 30 hospitals in India.
Results:
The majority of admitted children were aged between 11 and 18 years (70%) and boys (65.8%). Reasons for admission included respiratory distress, breathing difficulties, and prolonged fever. 75.3% were prescribed antibiotics typically empirically (68.3% overall), with most on the Watch list (76.7%). There were no differences in antibiotic prescribing whether hospitals followed guidelines or not. There was also appreciable prescribing of antimalarials (21.4% of children), antivirals (15.2%), and antiparasitic medicines (27.2%) despite limited evidence. The majority of children (92.2%) made a full recovery.
Conclusion:
It was encouraging to see low hospitalization rates. However, concerns about high empiric use of antibiotics and high use of antimalarials, antivirals, and antiparasitic medicines exist. These can be addressed by instigating appropriate stewardship programs.
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