Generic placeholder image

Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Research Article

Antibiotic use Evaluation in Hospitalized Pediatric Patients with Respiratory Tract Infections: A Retrospective Chart Review Study

Author(s): Amir Ali Mahboobipour, Shadi Baniasadi*, Elahe Saberi Shahrebabaki, Sabereh Tashayoie-Nejad and Maryam Hassanzad*

Volume 17, Issue 1, 2022

Published on: 18 February, 2021

Page: [17 - 23] Pages: 7

DOI: 10.2174/1574886316666210218104644

Price: $65

Abstract

Introduction: Respiratory tract infections (RTIs) are a common cause of antibiotic usage in hospitalized pediatric patients. Inappropriate use of antibiotics may lead to the emergence of multidrug-resistant microorganisms and increased treatment costs.

Objective: This study was designed to assess antibiotic usage in hospitalized pediatric patients with RTIs.

Methods: Medical charts of the patients admitted to the pediatric ward (PW) and pediatric intensive care unit (PICU) of a tertiary respiratory center were reviewed. Patients’ demographic and clinical data, including gender, age, weight, history of allergy, length of hospital stay, clinical diagnosis, and prescribed antibiotics (indication, dose, and frequency of administration) were collected. The appropriateness of antibiotic usage was evaluated in each patient according to international guidelines.

Results: Two hundred seventy-nine hospitalized patients were included in the study. The most common reason for hospitalization was pneumonia (38%), followed by cystic fibrosis (20.1%) and bronchitis (5%). The most commonly used antimicrobial agents were ceftriaxone, azithromycin, and clindamycin which guideline adherence for their usage was 85.3%, 23.3%, and 47%; respectively. Inappropriate dose selection was the main reason for non-adherence to the guidelines. The adherence rate to RTIs’ guidelines (considering all parameters for each patient) was 27.6%. Multivariate logistic regression analysis demonstrated CF and prescription of azithromycin are predictors of guideline non-adherence.

Conclusion: We found relatively low adherence to international guidelines in our center that could be related to restricted definitions of optimal antibiotic therapy. Despite most patients received logical antimicrobial therapy, actions should be taken into account to reach optimal antibiotic usage.

Keywords: Adherence, antibiotics, guideline, pediatrics, pulmonary infection, respiratory tract infections, treatment.

Graphical Abstract

[1]
Lakić D, Tadić I, Odalović M, Tasić L, Sabo A, Mećava A. Analysis of antibiotic consumption for treating respiratory tract infections in children and compliance with the national clinical guidelines. Med Pregl 2014; 67(9-10): 282-9.
[http://dx.doi.org/10.2298/MPNS1410282L] [PMID: 25546974]
[2]
Buccellato E, Melis M, Biagi C, Donati M, Motola D, Vaccheri A. Use of Antibiotics in Pediatrics: 8-Years Survey in Italian Hospitals. PLoS One 2015; 10(9): e0139097.
[http://dx.doi.org/10.1371/journal.pone.0139097] [PMID: 26405817]
[3]
Del Fiol FdeS, Lopes LC, Barberato-Filho S, Motta CdeC. Evaluation of the prescription and use of antibiotics in Brazilian children. Braz J Infect Dis 2013; 17(3): 332-7.
[http://dx.doi.org/10.1016/j.bjid.2012.10.025] [PMID: 23607920]
[4]
Shadmehr MB, Alaeen Z, Baniasadi S. Adherence to American Society of Health-System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study. J Pharm Pract Res 2020; 50: 22-7.
[http://dx.doi.org/10.1002/jppr.1557]
[5]
Mol PG, Rutten WJ, Gans RO, Degener JE, Haaijer-Ruskamp FM. Adherence barriers to antimicrobial treatment guidelines in teaching hospital, the Netherlands. Emerg Infect Dis 2004; 10(3): 522-5.
[http://dx.doi.org/10.3201/eid1003.030292] [PMID: 15109428]
[6]
Rogawski ET, Platts-Mills JA, Seidman JC, et al. Use of antibiotics in children younger than two years in eight countries: a prospective cohort study. Bull World Health Organ 2017; 95(1): 49-61.
[http://dx.doi.org/10.2471/BLT.16.176123] [PMID: 28053364]
[7]
Baniasadi S, Alaeen Z, Behgam Shadmehr M. Surgical antibiotic prophylaxis: A descriptive study among thoracic surgeons. Tanaffos 2016; 15(3): 154-9.
[PMID: 28210280]
[8]
Satari HI, Firmansyah A, Theresia T. Qualitative evaluation of antibiotic usage in pediatric patients. Paediatr Indones 2011; 51: 303.
[http://dx.doi.org/10.14238/pi51.6.2011.303-10]
[9]
Hersh AL, Jackson MA, Hicks LA. American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013; 132(6): 1146-54.
[http://dx.doi.org/10.1542/peds.2013-3260] [PMID: 24249823]
[10]
Ergül AB, Gökçek İ, Çelik T, Torun YA. Assessment of inappropriate antibiotic use in pediatric patients: Point-prevalence study. Turk Pediatri Ars 2018; 53(1): 17-23.
[http://dx.doi.org/10.5152/TurkPediatriArs.2018.5644] [PMID: 30083070]
[11]
Sviestina I, Mozgis D. Antimicrobial usage among hospitalized children in Latvia: A neonatal and pediatric antimicrobial point prevalence survey. Medicina (Kaunas) 2014; 50(3): 175-81.
[http://dx.doi.org/10.1016/j.medici.2014.08.005] [PMID: 25323546]
[12]
Mettler J, Simcock M, Sendi P, et al. Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study. BMC Infect Dis 2007; 7: 21.
[http://dx.doi.org/10.1186/1471-2334-7-21] [PMID: 17386104]
[13]
World Health Organization. WHO Global Strategy for Containment of Antimicrobial Resistance 2001.https://apps.who.int/iris/bitstream/handle/10665/66860/WHO_CDS_CSR_DRS_2001.2.pdf;jsessionid=17F0F20CF7965C9224DE3F858860F167?sequence=1 July 15, 2020. Available at
[14]
Ceyhan M, Yildirim I, Ecevit C, et al. Inappropriate antimicrobial use in Turkish pediatric hospitals: a multicenter point prevalence survey. Int J Infect Dis 2010; 14(1): e55-61.
[http://dx.doi.org/10.1016/j.ijid.2009.03.013] [PMID: 19487149]
[15]
Barson WJ. Pneumonia in children: inpatient treatment. In: Torchia MM, Ed. UpToDate https://www.uptodate.com July 15, 2020.
[16]
Simon RH. Cystic fibrosis: treatment of acute pulmonary exacerbations. In: Hoppin AG, Ed. UpToDate Available at:. https://www.uptodate.com [Access: July 15, 2020].
[17]
Bradley JS, Nelson JD, Barnett ED, et al. Nelson’s pediatric antimicrobial therapy. 23rd ed. Am. Acad. Ped. 2017; pp. 72-82.
[18]
Deptuła A, Trejnowska E, Dubiel G, et al. Use of ECDC PPS HAI&AU data to evaluate adherence to national guidelines for antimicrobial treatment of community-­acquired pneumonia. Pol Arch Intern Med 2018; 128(4): 209-15.
[http://dx.doi.org/10.20452/pamw.4209] [PMID: 29465065]
[19]
Boonstra E, Lindbaek M, Ngome E. Adherence to management guidelines in acute respiratory infections and diarrhoea in children under 5 years old in primary health care in Botswana. Int J Qual Health Care 2005; 17(3): 221-7.
[http://dx.doi.org/10.1093/intqhc/mzi020] [PMID: 15723818]
[20]
Di Pietro P, Della Casa Alberighi O, Silvestri M, et al. Pediatric Ligurian Network MAREA network. Monitoring adherence to guidelines of antibiotic use in pediatric pneumonia: the MAREA study. Ital J Pediatr 2017; 43(1): 113.
[http://dx.doi.org/10.1186/s13052-017-0432-2] [PMID: 29273072]
[21]
Triantafyllidis C, Kapordelis V, Papaetis GS, et al. Guidelines adherence for patients with community acquired pneumonia in a Greek hospital. Eur Rev Med Pharmacol Sci 2012; 16(1): 1-9.
[PMID: 22338542]
[22]
Kraj G, Peradzyńska J, Chądzyńska J, et al. The influence of national guidelines on the management of community-acquired pneumonia in children. Do pediatricians follow the recommendations? Adv Exp Med Biol 2019; 1211: 103-10.
[http://dx.doi.org/10.1007/5584_2019_392] [PMID: 31144241]
[23]
Launay E, Levieux K, Levy C, et al. GPIP. Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving: data from a prospective study in a French network. BMC Pediatr 2016; 16(1): 126.
[http://dx.doi.org/10.1186/s12887-016-0661-3] [PMID: 27520057]
[24]
Hagen TL, Hertz MA, Uhrin GB, Dalager-Pedersen M, Schønheyder HC, Nielsen H. Adherence to local antimicrobial guidelines for initial treatment of community-acquired infections. Dan Med J 2017; 64(6): A5381.
[PMID: 28566116]
[25]
Smyth AR, Bhatt J, Nevitt SJ. Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis. Cochr Database Syst Rev 2017; 3: CD002009.
[http://dx.doi.org/10.1002/14651858.CD002009.pub6] [PMID: 28349527]
[26]
Nayak-Rao S. Aminoglycoside use in renal failure. Indian J Nephrol 2010; 20(3): 121-4.
[http://dx.doi.org/10.4103/0971-4065.70839] [PMID: 21072150]
[27]
Kuscu F, Ulu A, Inal AS, et al. Potential drug-drug interactions with antimicrobials in hospitalized patients: A multicenter point-prevalence study. Med Sci Monit 2018; 24: 4240-7.
[http://dx.doi.org/10.12659/MSM.908589] [PMID: 29924770]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy