Chu-Ning Wang1, Benedikt D Huttner2, Nicola Magrini3, Yibing Cheng4, Jianning Tong5, Shuangjie Li6, Chaomin Wan7, Qingxiong Zhu8, Shiyong Zhao9, Zhiqiang Zhuo10, Daojiong Lin11, Bin Yi12, Qingwen Shan13, Mei Long14, Chunmei Jia15, Dongchi Zhao16, Xiaofeng Sun17, Juan Liu18, Yibo Zhou19, Rui Li5, Jing Liu20, Yu Zhu7, Ruixue Miao7, Chunhui Zhu8, Zhenghong Qi9, Caihong Wang10, Shouye Wu11, Xiaohong Xu21, Li Zhou21, Wenyu Ye13, Na Luo14, Huiling Gao22, Pu Yang16, Maihebuba Bieerding17, Jie Tang23, Mei Zeng24. 1. Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China. 2. Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 3. Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland. 4. Emergency Department, Henan Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China. 5. Department of Pediatric Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, China. 6. Department of Hepatology, Hunan Children's Hospital, Changsha, China. 7. Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China. 8. Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang, China. 9. Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou, China. 10. Department of Infectious Diseases, Xiamen Children's Hospital, Xiamen, China. 11. Department of Infectious Diseases, Hainan Women and Children's Medical Center, Hainan, China. 12. Department of Neonatology, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China. 13. Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China. 14. Department of Pediatric Gastroenterology, Guiyang Maternal and Child Hospital, Guiyang, China. 15. Department of Pediatrics, The Fourth Hospital of Baotou, Baotou, China. 16. Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China. 17. Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Wulumuqi, China. 18. Department of Pediatrics, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China. 19. Department of General Pediatrics, Henan Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China. 20. Department of Infectious Diseases, Hunan Children's Hospital, Changsha, China. 21. Department of Digestive Infection, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China. 22. Department of Pharmacy, The Fourth Hospital of Baotou, Baotou, China. 23. Department of Pharmacy, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China. 24. Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China. Electronic address: zengmeigao@aliyun.com.
Abstract
OBJECTIVES: To assess clinical indication-specific antibiotic prescribing in pediatric practice in China based on the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) metrics and to detect potential problem areas. STUDY DESIGN: Pediatric prescription records on the 16th of each month during 2018 were sampled for all encounters at outpatient and emergency departments of 16 tertiary care hospitals via hospital information systems. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) classification. RESULTS: A total of 260 001 pediatric encounters were assessed, and antibiotics were prescribed in 94 453 (36.3%). In 35 167 encounters (37.2%), at least 1 intravenous antibiotic was administered. WHO Watch group antibiotics accounted for 82.2% (n = 84 176) of all antibiotic therapies. Azithromycin (n = 15 791; 15.4%) was the most commonly prescribed antibiotic, and third-generation cephalosporins (n = 44 387; 43.3%) were the most commonly prescribed antibiotic class. In at least 66 098 encounters (70.0%), antibiotics were prescribed for respiratory tract conditions, mainly for bronchitis/bronchiolitis (n = 25 815; 27.3%), upper respiratory tract infection (n = 25 184; 26.7%), and pneumonia (n = 13 392; 14.2%). CONCLUSIONS: Overuse and misuse of WHO Watch group antibiotics for respiratory tract conditions and viral infectious diseases is common in pediatric outpatients in China. Pediatric antimicrobial stewardship should be strengthened using WHO AWaRe metrics.
OBJECTIVES: To assess clinical indication-specific antibiotic prescribing in pediatric practice in China based on the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) metrics and to detect potential problem areas. STUDY DESIGN: Pediatric prescription records on the 16th of each month during 2018 were sampled for all encounters at outpatient and emergency departments of 16 tertiary care hospitals via hospital information systems. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) classification. RESULTS: A total of 260 001 pediatric encounters were assessed, and antibiotics were prescribed in 94 453 (36.3%). In 35 167 encounters (37.2%), at least 1 intravenous antibiotic was administered. WHO Watch group antibiotics accounted for 82.2% (n = 84 176) of all antibiotic therapies. Azithromycin (n = 15 791; 15.4%) was the most commonly prescribed antibiotic, and third-generation cephalosporins (n = 44 387; 43.3%) were the most commonly prescribed antibiotic class. In at least 66 098 encounters (70.0%), antibiotics were prescribed for respiratory tract conditions, mainly for bronchitis/bronchiolitis (n = 25 815; 27.3%), upper respiratory tract infection (n = 25 184; 26.7%), and pneumonia (n = 13 392; 14.2%). CONCLUSIONS: Overuse and misuse of WHO Watch group antibiotics for respiratory tract conditions and viral infectious diseases is common in pediatric outpatients in China. Pediatric antimicrobial stewardship should be strengthened using WHO AWaRe metrics.
Authors: Shenghan Cai; Na Wang; Like Xu; Fei Yan; Qingwu Jiang; Xinping Zhao; Wei Wang; Hexing Wang; Lufang Jiang; Wenjuan Cong; Samuel K Sheppard; Jason Weeks; Barbara Kasprzyk-Hordern; Chaowei Fu; Helen Lambert Journal: Int J Environ Res Public Health Date: 2022-07-02 Impact factor: 4.614
Authors: Xiaodong Guan; Luwen Shi; Mengyuan Fu; Haishaerjiang Wushouer; Lin Hu; Nan Li; Dennis Ross-Degnan Journal: NPJ Prim Care Respir Med Date: 2021-05-10 Impact factor: 2.871