Policy brief: Optimising antimicrobial usage in paediatric inpatient hospital settings

Area of Science:

• Infectious Diseases
• Public Health
• Pharmacology

Background:

• Antimicrobial resistance (AMR) is a global health crisis exacerbated by antimicrobial overuse.
• Paediatric populations, especially inpatients, are vulnerable to infections and consume significant antimicrobial agents.
• Limited data exists on antimicrobial usage for healthcare-associated infections (HAIs) in neonates and children in low-to-middle income countries (LMICs), such as South Africa.

Purpose of the Study:

• To evaluate antimicrobial usage patterns in paediatric inpatients within South African academic public hospitals.
• To identify areas for improving the appropriateness of antimicrobial prescribing for HAIs.
• To inform strategies for combating AMR in a vulnerable population.

Main Methods:

• A cross-sectional study design was employed.
• Data on antimicrobial prescriptions for hospitalised children were collected and analysed.
• Antimicrobial selection was assessed against the WHO AWaRe classification system.

Main Results:

• 22.9% of hospitalised children received at least one antimicrobial.
• Neonates, infants, and adolescents exhibited higher HAI antimicrobial prescription rates.
• Commonly prescribed antimicrobials included penicillin, aminoglycosides, and carbapenems; selection generally aligned with WHO AWaRe guidelines.
• HIV infection was not identified as a risk factor for HAIs or increased antimicrobial use.

Conclusions:

• Optimizing antimicrobial prescribing in paediatric inpatients is crucial for combating AMR in South Africa.
• The 'PRACTICE' acronym summarizes key strategies: standardized policies, therapy review, age-specific stewardship, collaboration, and research.
• Implementing infection prevention, surveillance, and electronic stewardship tools are vital for improving antimicrobial use and patient outcomes.