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Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review
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Abstract Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0–18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
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“A systematic review, on implementation of AMS in paediatrics, identified more than half the included studies were from the USA, with 18% (20/113) studies from Asia.16”
From Rationalizing irrational prescribing—infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India (2024) · cites this paper as [16]
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Metadata
- Authors
- Donà, D., Barbieri, E., Daverio, M., Lundin, R., Giaquinto, C., Zaoutis, T., & Sharland, M.
- Affiliations
- University of Padua (IT)
- PENTA Foundation (IT)
- Children's Hospital of Philadelphia (US)
- St George's, University of London (GB)
- Corresponding author
- Barbieri, E.
- Venue
- Antimicrobial Resistance & Infection Control
- Published
- 2020-01-03
- Volume
- 9
- Issue
- 1
- Pages
- 3-3
- ISSN
- 2047-2994 (ISSN-L)
- PMC
- PMC6942341
- OpenAlex
- W2998803677
- Cited by
- 199
- References
- 159
- Citations by year
- 2026: 29 · 2025: 39 · 2024: 32 · 2023: 31 · 2022: 21 · 2021: 32 · 2020: 15
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-05-07)
- Open access
- gold
- doi.org
- Locations
- Antimicrobial Resistance and Infection Control (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Keywords
- antibiotic misuse, inappropriate antibiotic prescribing, antimicrobial resistance, health care costs, empirical antibiotic therapy, extended-spectrum beta-lactamase, carbapenem resistance, macrolide resistance, implementation outcomes
- MeSH terms
- Antimicrobial Stewardship, Anti-Bacterial Agents, Asia, Bacteria, Bacterial Infections, Child, Europe, Humans, Pediatrics, United States, Global Health, Drug Resistance, Bacterial, Inappropriate Prescribing, Prescription Drug Misuse
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