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Up to 34% of antibiotic scripts for kids are “inappropriate”

UP to 34% of prescriptions for antimicrobials given to hospitalized Australian children may be inappropriate, according to research published in the Medical Journal of Australia.

The threat of antimicrobial resistance and its impact on health care settings globally are well recognised. Antibiotic use is the main driver of the development of resistance, but there is a lack of data on antibiotic prescribing for hospitalized children.

A group of researchers led by A/Prof Penelope Bryant, from The Royal Children’s Hospital Melbourne conducted a one-day survey on behalf of the Australian and New Zealand Paediatric Infectious Diseases group across eight Australian children’s hospitals to measure the quantity and quality of antimicrobial prescribing.

Of 1373 children, 46% (631) were prescribed at least one antimicrobial agent, 31% (198) of whom were under 1 year old.

The Medical Journal of Australia is a publication of the Australian Medical Association.

Overall, 957 prescriptions (82%) were deemed appropriate, but this varied between hospitals (66% to 95%) and specialties (65% to 94%).

The Medical Journal of Australia is a publication of the Australian Medical Association.

Among surgical patients, 65 of 187 antimicrobial prescriptions (35%) were deemed inappropriate, and a common reason for this was excessive prophylaxis duration.

The highest antimicrobial prescribing rates were in haematology and oncology wards (76%) and paediatric intensive care units (55%). Of 912 antibacterial prescriptions, 331 (36%) were ‘broad- spectrum’ antibiotics, although only 18 (2%) in the broadest category that may cause the highest level of resistance.

The overall prescription rate of 46% was “markedly higher” than the average rate of 35% for hospitalised children in European countries, the authors wrote.

“Overall, a high proportion (82%) of prescriptions were deemed appropriate”, they wrote. “However, 28% of patients received at least one inappropriately prescribed drug. “With 40% of surgical patients receiving at least one antimicrobial prescription deemed inappropriate, one area for targeting would be the use of perioperative prophylaxis, for which there are consensus guidelines.”

The researchers said the strength of their point prevalence study (PPS) was its ability to take a “snapshot” of quantitative and qualitative data across locations at a single time.

The study provides opportunities for quality improvement. “It provides a baseline for ongoing audits by antimicrobial stewardship (AMS) teams, conducted in individual hospitals and as multisite collaborations”, the authors wrote.

They said that AMS interventions improve outcomes. “As hospitals adopt integrated electronic medical record and prescribing systems, there is a new opportunity to incorporate AMS principles into day-to-day hospital work … and subsequently move to a system of continuous monitoring of prescribing patterns.”

Source

The Medical Journal of Australia is a publication of the Australian Medical Association.

Medical Journal of Australia (MJA)