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Published on: August 30, 2018
Use of antimicrobials in pediatric wards of five Brazilian hospitals
Thais de Barros Fernandes1, Sheila Feitosa Ramos2, Luísa Rodrigues Furtado Leitzke3
1Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, 21041-210, Brazil. fernandes.thaisb@gmail.com.
Insights
Antimicrobial use in hospitalized children in Brazil is high and varies significantly between hospitals, with frequent off-label prescribing, particularly for azithromycin. This highlights a need for improved antimicrobial stewardship in pediatric care.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology and Therapeutics
- Public Health and Epidemiology
Background:
- Antimicrobial (AM) use in children is common, yet inappropriate use contributes to antimicrobial resistance.
- Off-label (OL) antimicrobial prescribing is prevalent in pediatric populations, increasing the risk of drug-related problems.
- There is a notable lack of drug utilization review (DUR) data for pediatric antimicrobial use in Brazil and Latin America.
Purpose of the Study:
- To characterize antimicrobial utilization patterns in hospitalized children across five Brazilian hospitals.
- To assess the extent and characteristics of off-label antimicrobial use in this pediatric cohort.
- To identify variations in antimicrobial prescribing and identify factors associated with off-label use.
Main Methods:
- An observational study was conducted in pediatric wards of five hospitals in Brazil (CE, SE, RJ, RS, DF).
- Data on antimicrobial use were collected from patient medical records and prescriptions over a six-month period per hospital.
- Antimicrobial utilization was quantified using Days of Therapy (DOT) and Length of Therapy (LOT) per 1000 patient days, with off-label use analyzed by age.
Main Results:
- Data from 1020 pediatric patients were analyzed, revealing significant variations in DOT/1000PD (278-517) and LOT/1000PD (265-390) across hospitals.
- Respiratory tract infections were the most common indication for antimicrobial use. Antimicrobial utilization was highest in the Sergipe (SE) hospital.
- Off-label use was more prevalent in the Rio de Janeiro (RJ) hospital, infants, patients with prolonged stays, and those receiving multiple antimicrobials. Azithromycin showed the highest OL prevalence.
Conclusions:
- Overall antimicrobial use in hospitalized children in Brazil is high and exhibits considerable inter-hospital variability, influenced by local factors and prescribing habits.
- Off-label prescribing is a significant concern, particularly for specific antimicrobials like azithromycin and in certain patient subgroups.
- Findings underscore the need for enhanced antimicrobial stewardship programs and DUR initiatives in Brazilian pediatric healthcare settings.
Abstract:
The use of antimicrobials (AMs) in pediatric infections is common practice and use may be inappropriate leading to antimicrobial resistance. Off-label AM use is also common in this group and can result in drug-related problems. There is lack of DUR data in Brazil and in Latin America, specially for AM pediatric use. The aim of this study was to describe the utilization of AMs in hospitalized children in five hospitals in Brazil. We conducted an observational study of the utilization of AMs in pediatric wards in hospitals in the states of Ceará (CE), Sergipe (SE), Rio de Janeiro (RJ), Rio Grande do Sul (RS) and the Federal District (DF). Data derived from patient medical records and prescriptions were collected over a six-month period in each hospital. The number of AMs used by each patient was recorded, and AM use was assessed using Days of therapy (DOT) and Length of therapy (LOT) per 1000 patient days according to different patient characteristics. Off-label (OL) use was described according to age. The study analyzed data from 1020 patients. The sex and age distributions were similar across the five hospitals. However, differences were found for comorbidities, history of ICU admission and length of hospital stay. The most common diseases were respiratory tract infections. There were wide variations in DOT/1000PD (278-517) and LOT/1000PD (265-390). AM utilization was highest in the hospital in SE. The consumption of second-generation penicillins and cephalosporins was high. The prevalence of OL use of AMs was higher for patients in the RJ hospital, in infants, in patients who underwent prolonged hospital stays, and in patients who used multiple AMs. The AM that showed the highest prevalence of OL use was azithromycin, in both oral and parenteral formulations. Overall AM use was high and showed differences in each setting, possibly influenced by local characteristics and by prescribing standards adopted by pediatricians.
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