SuperbugsToo many hospitalized kids receive preventive antibiotics

A large new international study indicates that nearly a third of hospitalized children are receiving antibiotics to prevent bacterial infections rather than to treat them, and in many cases are receiving broad-spectrum antibiotics or combinations of antibiotics.

The authors of the study say this high rate of prophylactic prescribing in pediatric patients and frequent use of broad-spectrum agents suggests a clear overuse of antibiotics in this population and underscores the need for pediatric-specific antibiotic stewardship programs.

“In pediatrics, there is far too much unnecessary—as well as too much inappropriate—antibiotic prescribing,” lead study author Markus Hufnagel, MD, PhD, a pediatric infectious disease (ID) specialist and professor at University Children’s Hospital in Freiburg, Germany, told CIDRAP News. “It is critical for us to preserve the antibiotics that we use, especially since at least to date, there has been little interest in investing in the development of new antibiotics.”

Antibiotics for surgical, medical prophylaxis
CIDRAP says that the study, published yesterday in the Journal of Pediatric Infectious Diseases Society, evaluated preventive, or prophylactic, antibiotic prescribing practices in 17,693 children at 226 pediatric hospitals in 41 countries, including the United States. The participating hospitals were asked to conduct a 1-day point-prevalence survey (PPS) from October 2012 through November 2012, and investigators then identified children who received at least one antibiotic for prophylactic indications on the day of the survey.

Overall, 6,818 hospitalized children received antibiotic prescriptions, with 2,242 children (32.9 percent) receiving at least one antibiotic for prophylactic use. Of the 3,400 antibiotic prescriptions written for prophylactic use, 905 (26.6 percent) were intended to prevent infections from upcoming surgeries, and 2,495 (73.4 percent) were to prevent infections associated with medical conditions.

Hufnagel said he and his colleagues did not expect these results.

“Given this large data set, for us there were two big surprises,” he said. “First, discovering that a full third of overall antimicrobial prescriptions were for prophylaxis, and second, finding that the rate of medical prophylactic prescribing was even higher than that for surgical prophylaxis.”

While the study notes that using antibiotics to prevent infections is contentious, giving adult and pediatric patients antibiotics a few hours prior to surgery is common practice; the purpose is to prevent surgical-site infections (SSIs). Guidelines for surgical prophylaxis emphasize short duration and focused use.