26% of hospitalized kids on antibiotics receive suboptimal prescription
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More than one-quarter of hospitalized children receiving antibiotics receive a suboptimal prescription, and almost half of suboptimal orders are not reviewed by an antimicrobial stewardship program, or ASP, according to data from 32 U.S. children’s hospitals.
“There is still room for improvement in optimizing antibiotic prescribing for hospitalized children,” Alison C. Tribble, MD, assistant professor of pediatrics at the University of Michigan, told Healio. “One-quarter of children receiving antibiotics in our study were receiving at least one suboptimally prescribed antibiotic. Almost two-thirds of suboptimal prescribing was due to overprescribing.”
Tribble and colleagues analyzed data on 34,927 hospitalized children from July 2016 through December 2017. Among them, 35% (n = 12,213) received one or more antibiotics, including 11,784 who received an antibiotic for infectious use. Of those patients, 25.9% were prescribed at least one suboptimal antibiotic.
They performed an analysis of suboptimal use on close to 99% of antibiotic orders. Of that percentage, 21% were considered suboptimal, with about 14% classified as inappropriate and 7% classified as appropriate but needing modification.
The most frequent reasons for a suboptimal antibiotic order were “bug-drug mismatches” that required narrowing or broadening of therapy and surgical prophylaxis, Tribble and colleagues reported.
“The extent to which surgical prophylaxis was considered inappropriate, and the volume of this use, while not entirely surprising, was impressive,” Tribble said. “This is especially so because this is likely an underestimate, given the more recent recommendations to eliminate most postoperative prophylaxis altogether.”
The study showed that 46% of suboptimal antibiotic orders were not reviewed by an ASP as a part of their daily practice — “arguably the most important finding,” the researchers wrote.
“Despite the efforts and growth of these programs in the past decade, there is still a lot of work to be done,” Tribble said. “Almost half of the inappropriately prescribed antibiotics in our study would not have been reviewed by ASPs, and we identified a fair amount of inappropriate use among antibiotics that are not always considered high-yield targets for review, such as ceftriaxone, cefazolin and clindamycin.”
Tribble said continued regulatory support for ASPs is “critical.”
“ASPs have been consistently shown to improve antibiotic prescribing in hospitals, but even despite those efforts, we still find substantial rates of inappropriate prescribing,” she said. “ASPs are already stretched thin, and they will need continued support and resources to be able to further impact antibiotic prescribing.” – by Ken Downey Jr. and Eamon Dreisbach
Disclosures: Tribble reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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