Yielding not to temptation: The difficult job of taking unnecessary antibiotics away from children

January 12th, 2015

Reducing antibiotic overuse and unnecessary administration in children would go a long way in slowing the rise of drug-resistant pathogens, but there is an understandable temptation to do everything possible for the child and distraught parents. Knowing that many of these antibiotics are not actually clinically needed or could create additional medical problems, the Pediatric Infectious Diseases Society has stepped to the forefront in support of antibiotic stewardship programs (ASP).

The effort is starting to yield results, including a study that found a 19% reduction in use of the kind of broad spectrum antibiotics known to select out resistant organisms. A companion article describes how an antibiotic stewardship program (ASP) was created within a 317-bed tertiary care children's hospital and clinicians' attitudes toward it—the first published account of such a pediatric program.

In an effort that ran over three years and included almost 9,000 patients, the authors observed a significant decrease in antibiotic usage—ranging from a 37% decrease in the early months, to 13% at the end of the observation.

In the companion article, researchers describe the five-part process they used to create their ASP. The components included forming a multi-disciplinary team; determining the type of program (prospective-audit-with-feedback) and which antimicrobials to monitor; deciding which mechanism to use in identifying patients (a report was created in the hospital's EMR system); developing and implementing an evaluation process; and, communicating the goals and logistics of the ASP to the hospital's affected clinicians.

The authors surveyed 365 clinicians; the 56% who responded had a positive view of the ASP. The overwhelming majority agreed that the ASP had improved the use (83%) of antibiotics, decreased their inappropriate use (84%), and improved the quality of patient care (82%). An ASP goal was to provide education to those affected by the program; 90% said it did and 66% agreed it led to practice changes. Of negative feelings, only 6% felt the ASP interfered with clinical decision-making and 5% thought the ASP's recommendations were “threatening.”