Paediatric Antimicrobial Stewardship

While children and adults have different antimicrobial needs, antimicrobial stewardship (AMS) principles are the same. There is much less information regarding the implementation and effectiveness of AMS in paediatric hospitals.

An Australian-wide point prevalence survey in paediatric hospitals identified 28% of reviewed patients having at least one prescription that was considered to be inappropriate. Prescriptions were considered inappropriate if the wrong antimicrobial was prescribed, inappropriate dose, route, dose interval or duration was used, or if an antimicrobial was prescribed unnecessarily. Surgical patients were identified as a particular area where antimicrobial prescribing could be improved.

Paediatric AMS is clearly needed, however, paediatric representatives are often missing from AMS teams. Half of Australian and New Zealand tertiary paediatric hospitals surveyed in 2013 did not include a paediatric representative on the AMS team. Only one of the 14 tertiary centres had an ongoing paediatric ID position dedicated to AMS and that was only 1 day per fortnight. A lack of paediatric specific antimicrobial prescribing guidelines was also identified.

Improving antimicrobial prescribing is as important in paediatrics as adults. Unfortunately, different tools and guidelines are needed and development of these can be difficult due to the lack of paediatric specific evidence. Education, both in hospital and community practice, about the appropriate use of antibiotics in children is an important step. Paediatric patients should be an important consideration in the development of AMS programs.

More information on paediatric antimicrobial stewardship and the paediatric point prevalence study is available from the MJA.

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