For one-quarter of the patients in US children’s hospitals taking at least one antibiotic, the treatments are unnecessary or otherwise “suboptimal,” according to new research.
The overuse of antibiotics poses an increasing threat to children who develop—or already have—drug-resistant infections that are difficult or impossible to treat. They can cause extended hospitalization, disability, and even death.
At any given time, about 1 in 3 patients in US children’s hospitals receive one or more antibiotics.
“Health care workers must be vigilant since the inappropriate use of antibiotics is fueling dangerous drug resistance in children.”
The study, which involved nearly 12,000 children at 32 US children’s hospitals, also shows that current antibiotic stewardship programs designed to prevent antibiotic resistance would have missed nearly half of this inappropriate use of antibiotics. These programs involve the routine review of certain patient prescriptions to determine if patients are getting the correct dose, drug, and duration.
“Antibiotic resistance is a growing danger to everyone; however, there is limited data on children,” says Jason Newland, a professor of pediatrics in the Division of Pediatric Infectious Diseases at Washington University School of Medicine in St. Louis and director of the Antimicrobial Stewardship Program at St. Louis Children’s Hospital, where he treats patients.
“Data on adults have suggested that 30% to 50% of antibiotics used in hospitalized adults is inappropriate,” Newland says. “Our goal was to understand if antibiotics used to treat hospitalized children were suboptimal, meaning doctors shouldn’t have prescribed any antibiotics; they could have used a more effective antibiotic; or they could have prescribed a different dose or for a shorter duration. Health care workers must be vigilant since the inappropriate use of antibiotics is fueling dangerous drug resistance in children.”
The multicenter study involved examining the medical records of 11,784 children from birth to age 17 who had been prescribed, in 32 US children’s hospitals, one or more antibiotics to treat or prevent infections. The researchers evaluated data collected on six separate days from July 2016 through December 2017.
Researchers found 2,946 (25%) of the patients received at least one antibiotic deemed suboptimal.
Altogether, health care providers prescribed antibiotics 17,110 times. Of those, 3,593 were considered suboptimal. The most common cases of inappropriate antibiotic use included:
- 27% due to “bug-drug mismatch,” meaning the patient got the wrong antibiotic for a particular infection.
- 17% due to prolonged antibiotic use after surgery to prevent surgical-site infections.
- 11% due to use of antibiotics when they were unnecessary.
- 11% due to use of broad-spectrum antibiotics, when a drug that targets a specific type of bacteria could have been used.
The study also shows that physicians and pharmacists involved in hospital antimicrobial stewardship programs, which only scrutinized the use of specific drugs, would not have routinely reviewed almost half of the suboptimal prescriptions the researchers identified.
“Arguably, this is one of the most important findings because it helps us to identify blind spots in antimicrobial stewardship programs,” Newland says. “Antibiotics currently not targeted for review still have a significant need for oversight. The obvious solution is to expand routine reviews to include all antibiotics. Unfortunately, this is resource-intensive and may not be feasible at some hospitals.”
However, the study also pinpointed medical conditions that would benefit from increased scrutiny. For example, the most common medical condition for antibiotic prescriptions was bacterial lower respiratory tract infection, or pneumonia. It also accounted for the greatest percentage of suboptimal prescriptions—18%.
A number of suboptimal prescriptions stemmed from drugs used to prevent surgical-site infections, mainly because doctors prescribed the drug for longer than necessary.
“Notably, recently revised guidelines from the Centers for Disease Control and Prevention recommend that some surgeries limit antibiotics to a single preoperative dose,” Newland says. “This means that an even greater proportion of the cases in our study now would be considered suboptimal.”
“Our study also highlights the need for antimicrobial stewardship programs to expand current practices and efforts,” Newland says. “Such evolution is imperative to ensure optimal antibiotic use for all hospitalized children.”
The research appears in Clinical Infectious Diseases.
Additional researchers are from the University of Michigan; Children’s Mercy Hospital in Kansas City, Missouri; Novant Health Eastover Pediatrics in Charlotte, North Carolina; the University of Pennsylvania; Children’s Hospital of Philadelphia; University of Utah; and the University of Washington. Researchers recruited participating hospitals through the Sharing Antimicrobial Reports for Pediatric Stewardship Collaborative, which Newland co-founded and currently leads.
Support for the research came from an investigator-initiated grant from the pharmaceutical company Merck. Jason Newland and Brian Lee received grant support from Merck to complete this study.