Related Experiment Video
Updated: Jun 5, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Antimicrobial Use Among Hospitalized Neonates and Children; Findings and Implications from a Comprehensive Point
Zia Ul Mustafa1,2, Muhammad Salman3, Amer Hayat Khan1
1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, 11800, Malaysia.
Insights
Antibiotic use is extremely high in hospitalized children in Pakistan, with 96.3% receiving them. Urgent antimicrobial stewardship programs are needed to combat inappropriate prescribing and antimicrobial resistance.
Area of Science:
- Global Health
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial resistance (AMR) is a critical global health challenge.
- Excessive antibiotic use, particularly in low- and middle-income countries like Pakistan, fuels AMR.
- The pediatric population in Pakistan faces high rates of antibiotic prescribing due to vulnerability.
Purpose of the Study:
- To assess antimicrobial use in hospitalized neonates and children in Pakistan's tertiary care hospitals.
- To identify patterns and appropriateness of antibiotic prescribing in this vulnerable population.
- To provide data for developing interventions against antimicrobial resistance.
Main Methods:
- A point prevalence survey (PPS) was conducted across 14 tertiary care hospitals in Punjab Province, Pakistan.
- The survey included 1811 neonates and children admitted to pediatric wards.
- Data collected included antibiotic prescriptions, indications, administration routes, and empirical use.
Main Results:
- A high prevalence of antibiotic use was observed, with 96.3% of patients (1744/1811) prescribed antibiotics.
- An average of 1.57 antibiotics per patient was recorded, with 85.6% administered parenterally.
- Antibiotics were frequently prescribed empirically (92.2%), prophylactically (34.4%), and often without a documented rationale or stop date (86.2% and 77.6%, respectively).
- A significant proportion of prescribed antibiotics (75.2%) were from the 'Watch' category.
Conclusions:
- There is a very high prevalence of antibiotic use, including 'Watch' antibiotics, among hospitalized neonates and children in Pakistan.
- Current prescribing practices indicate significant inappropriateness, mirroring previous findings.
- Implementing antimicrobial stewardship programs is crucial to address inappropriate antibiotic prescribing and mitigate AMR.
Purpose:
Antimicrobial resistance is a global health crisis exacerbated by excessive and inappropriate use of antibiotics, especially among low- and middle-income countries including Pakistan. The paediatric population is a key area in view of their vulnerability and excessive prescribing of antibiotics in Pakistan. Consequently, there is an urgent need to robustly assess antimicrobial use among hospitalized neonates and children in tertiary hospitals in Pakistan as they are generally the training centres for new physicians subsequently treating children.
Patients And Methods:
A point prevalence survey (PPS) was conducted in the children's wards of 14 tertiary care hospitals in Punjab Province, covering over 50% of the population of Pakistan. This builds on a previous PPS among tertiary care hospitals treating exclusively neonates and children.
Results:
A total of 1811 neonates and children were surveyed with 1744 patients prescribed antibiotics, a prevalence of 96.3%. A total of 2747 antibiotics were prescribed to these 1744 neonates and children, averaging 1.57 antibiotics per patient. Overall, 57.7% of the patients were prescribed one antibiotic and 27.2% two antibiotics, with 85.6% of antibiotics administered parenterally. Over a third (34.4%) of the antibiotics were prescribed prophylactically, with 44.7% of them for surgical procedures. Among those prescribed antibiotics for surgical procedures, 75.2% were prescribed for more than one day. Overall, 92.2% of antibiotics were prescribed empirically, with 86.2% prescribed without mentioning the rationale for their choice in the notes, with 77.6% having no stop date. Respiratory tract infections were the most common indication (43.4%). Staphylococcus species (36.0%) were the most common pathogen with limited Culture and Sensitivity Testing performed. Three quarters (75.2%) of antibiotics were from the Watch list, and 24.4% were Access antibiotics.
Conclusion:
A very high prevalence of antibiotic use among neonates and children in tertiary hospitals in Pakistan, including Watch antibiotics, mirroring previous studies. Consequently, initiatives including antimicrobial stewardship programmes are urgently needed to address current inappropriate prescribing.
Related Concept Videos
01:28Antimicrobial Effectiveness
01:23Hand hygiene
Hand washing...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...