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Antibiotics
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Inappropriate Use of Antibiotics in Pediatrics
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Inappropriate Use of Antibiotics in Pediatrics

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 5623

Special Issue Editor

Dr. Brian R. Lee

E-Mail Website
Guest Editor
Department of Health Services and Outcomes Research, Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
Interests: antimicrobial stewardship; health disparities; epidemiology; clinical decision making; diagnostic microbiology

Special Issue Information

Dear Colleagues,

This Special Issue will collect all knowledge related to inappropriate prescriptions of antibiotics in pediatric patients. Prior research has shown that an estimated 20–50% of prescribed antibiotics are considered unnecessary. This pattern has been demonstrated in both inpatient and outpatient scenarios, though research has not focused solely on the pediatric population. Tribble and colleagues examined over 17,000 antibiotic orders among admitted pediatric patients from 32 hospitals and classified 21% of these orders as suboptimal/inappropriate [Clin Infect Dis; doi:10.1093/cid/ciaa036]. Nearly half of these suboptimal/inappropriate orders in that study would not have been routinely identified by antimicrobial stewardship programs. Diggs and colleagues conducted a similar study and reported that of the 13,000 antibiotic orders, 13.8% were considered inappropriate [Infect Control Hosp Epidemiol; doi:10.1017/ice.2023.56]. One key finding from this study was the substantial variation in inappropriate prescriptions by clinical service, including the highest levels of inappropriateness in PICU (19.4%) and surgical sub-specialty (22.5%) pediatric patients. A recent analysis of U.S. MarketScan commercial inpatient/outpatient pediatric claims data revealed that approximately 30% of the antibiotics used for bacterial infections and up to 70% of viral infections were considered inappropriate [JAMA Netw Open; doi:10/1001/jamanetworkopen.2022.14153]. More research is needed to not only fully understand the overall prevalence of inappropriate use, but also elucidate reasons for this inappropriateness, identify key drivers, and identify intervention opportunities. 

Dr. Brian R. Lee
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • inappropriate antibiotic prescription
  • antimicrobial resistance
  • pediatrics

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Published Papers (3 papers)

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Research

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12 pages, 1466 KiB  
Article
Implementation of a Multifaceted Program to Improve the Rational Use of Antibiotics in Children under 3 Years of Age in Primary Care
by Santiago Alfayate-Miguélez, Gema Martín-Ayala, Casimiro Jiménez-Guillén, Manuel Alcaraz-Quiñonero, Rafael Herrero Delicado and José Arnau-Sánchez
Antibiotics 2024, 13(7), 572; https://doi.org/10.3390/antibiotics13070572 - 21 Jun 2024
Viewed by 1709
Abstract
A multifaceted, participatory, open program based on a qualitative and quantitative approach was developed in the Region of Murcia (Spain) aimed to reduce antibiotic use in children under 3 years of age diagnosed with upper respiratory tract infections (acute otitis media, pharyngitis, and [...] Read more.
A multifaceted, participatory, open program based on a qualitative and quantitative approach was developed in the Region of Murcia (Spain) aimed to reduce antibiotic use in children under 3 years of age diagnosed with upper respiratory tract infections (acute otitis media, pharyngitis, and common cold). Antibiotic consumption was measured using the defined daily dose per 1000 inhabitants per day (DHD). Pre-intervention data showed a prevalence of antibiotic prescriptions in the primary care setting of 45.7% and a DHD of 19.05. In 2019, after the first year of implementation of the program, antibiotic consumption was 10.25 DHD with an overall decrease of 48% as compared with 2015. Although antibiotic consumption decreased in all health areas, there was a large variability in the magnitude of decreases across health areas (e.g., 12.97 vs. 4.77 DHD). The intervention program was effective in reducing the use of antibiotics in children under 3 years of age with common upper respiratory diseases, but reductions in antibiotic consumption were not consistent among all health areas involved. Full article
(This article belongs to the Special Issue Inappropriate Use of Antibiotics in Pediatrics)
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Review

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31 pages, 5237 KiB  
Review
State of the Art of Antimicrobial and Diagnostic Stewardship in Pediatric Setting
by Daniele Donà, Elisa Barbieri, Giulia Brigadoi, Cecilia Liberati, Samantha Bosis, Elio Castagnola, Claudia Colomba, Luisa Galli, Laura Lancella, Andrea Lo Vecchio, Marianna Meschiari, Carlotta Montagnani, Maia De Luca, Stefania Mercadante and Susanna Esposito
Antibiotics 2025, 14(2), 132; https://doi.org/10.3390/antibiotics14020132 - 27 Jan 2025
Cited by 1 | Viewed by 2179
Abstract
Antimicrobial stewardship programs (ASPs) and diagnostic stewardship programs (DSPs) are essential strategies for effectively managing infectious diseases and tackling antimicrobial resistance (AMR). These programs can have a complementary impact, i.e., ASPs optimize antimicrobial use to prevent resistance, while DSPs enhance diagnostic accuracy to [...] Read more.
Antimicrobial stewardship programs (ASPs) and diagnostic stewardship programs (DSPs) are essential strategies for effectively managing infectious diseases and tackling antimicrobial resistance (AMR). These programs can have a complementary impact, i.e., ASPs optimize antimicrobial use to prevent resistance, while DSPs enhance diagnostic accuracy to guide appropriate treatments. This review explores the current landscape of ASPs and DSPs in pediatric care, focusing on key factors, influencing their development, implementation, and evaluation across various settings. A multidisciplinary approach is necessary, involving multiple healthcare professionals to support comprehensive stewardship practices in pediatric care. No single intervention suits all settings, or even the same setting, in different countries; interventions must be tailored to each specific context, considering factors such as hospital capacity, patient complexity, and the parent–child dynamic. It is essential to educate caregivers on optimal antibiotic use through clear, concise messages adapted to their socioeconomic status and level of understanding. The cost-effectiveness of ASPs and DSPs should also be assessed, and standardized metrics should be employed to evaluate success in pediatric settings, focusing on outcomes beyond just antibiotic consumption, such as AMR rates. This manuscript further discusses emerging opportunities and challenges in ASP implementation, offering insights into future research priorities. These include large-scale studies to evaluate the long-term impact of ASPs, cost-effectiveness assessments of pediatric-specific diagnostic tools, and the integration of artificial intelligence to support clinical decision making. Addressing these areas will enhance the effectiveness and sustainability of ASPs, contributing to global efforts to combat AMR and improve pediatric health outcomes. Full article
(This article belongs to the Special Issue Inappropriate Use of Antibiotics in Pediatrics)
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14 pages, 618 KiB  
Review
Antimicrobial Stewardship Programs in Pediatric Intensive Care Units: A Systematic Scoping Review
by Cecilia Liberati, Giulia Brigadoi, Elisa Barbieri, Carlo Giaquinto and Daniele Donà
Antibiotics 2025, 14(2), 130; https://doi.org/10.3390/antibiotics14020130 - 26 Jan 2025
Viewed by 1118
Abstract
Objectives: We aimed to summarize the current state of antimicrobial stewardship (ASP) and diagnostic stewardship programs (DSPs) implemented in pediatric intensive care units (PICUs). Methods: Embase, MEDLINE, Scopus and the Cochrane Library were searched, including studies from 1 January 2007 to [...] Read more.
Objectives: We aimed to summarize the current state of antimicrobial stewardship (ASP) and diagnostic stewardship programs (DSPs) implemented in pediatric intensive care units (PICUs). Methods: Embase, MEDLINE, Scopus and the Cochrane Library were searched, including studies from 1 January 2007 to 20 February 2024. Studies were included in the review if they assessed the implementation of an ASP or a DSP in a PICU. Identified references were downloaded into Rayyan software, and data were extracted using a standardized data collection form. Results: 18 studies were included; 13 described an ASP intervention, and 5 described a diagnostic stewardship intervention. Most studies were retrospective and adopted a persuasive strategy for ASP, reporting positive effects on antimicrobial consumption. However, studies were dramatically heterogeneous in terms of intervention type, outcomes and metrics used, limiting the possibility of a broader comparison. Diagnostic stewardship studies included mainly the impact of biomarkers and pathogen testing panels without significant impact on antibiotic prescription patterns. Antimicrobial resistance changes were not described by the majority of studies. Conclusions: the implementation of ASP in PICUs is still limited, with significant variability in the metrics used to evaluate outcomes. To enhance the effectiveness of these programs, it is crucial to harmonize reporting metrics to allow an adequate comparison of results and to find the best strategies to inform ASP in PICUs. Full article
(This article belongs to the Special Issue Inappropriate Use of Antibiotics in Pediatrics)
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