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Antibiotics
Special Issues
Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients
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Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 14472

Special Issue Editors

Dr. Costanza Vicentini

E-Mail Website
Guest Editor
Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126 Torino, Italy
Interests: infection control; antimicrobial stewardship; antimicrobial resistance; healthcare-associated infections; infectious disease epidemiology and surveillance
Prof. Dr. Carla Maria Zotti

E-Mail Website
Guest Editor
Department of Public Health and Pediatrics, University of Turin, Turin, Italy
Interests: infectious disease control; antimicrobial stewardship; antimicrobial resistance; healthcare-associated infections; infectious disease epidemiology and surveillance

Special Issue Information

Dear Colleagues,

Clear evidence indicates antibiotic overuse is among the most important contributing factors in the growing problem of antimicrobial resistance. Improving prescribing practices and promoting a more judicious use of antibiotics are recognized as patient safety and public health priorities. Children are high consumers of antimicrobial agents: antibiotics are the most commonly prescribed therapeutic agents in the pediatric population worldwide, although 50% of all pediatric antimicrobial prescriptions are estimated to be unnecessary. To develop an effective strategy to manage antibiotic resistance, reliable measurements of childhood antimicrobial consumption and prescribing patterns both in acute settings and the community, as well as their impact on resistance, are crucial. However, most metrics and indicators applicable to adult patients are not directly applicable to childhood antibiotic use due to the absence of age-specific pediatric defined daily dosages, age-related differences in the prevalence of infections, and differences in prescription patterns between adults and children.

This Special Issue seeks manuscript submissions that provide further insights into childhood prescribing and resistance patterns in both hospital and outpatient settings and investigate their impact on patient care and antibiotic prescribing policy. Submissions focusing on the development or application of childhood-specific metrics and quality indicators are particularly encouraged.

Dr. Costanza Vicentini
Prof. Dr. Carla Maria Zotti
Guest Editors

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

  • antibiotic use
  • prescribing practices
  • antimicrobial resistance
  • pediatric patients
  • quality indicators
  • metrics

Published Papers (7 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 185 KiB  
Editorial
Editorial for the Special Issue “Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients”
by Costanza Vicentini and Carla Maria Zotti
Antibiotics 2023, 12(9), 1390; https://doi.org/10.3390/antibiotics12091390 - 31 Aug 2023
Viewed by 666
Abstract
Antibiotic overuse is among the most important factors contributing to the growing problem of antimicrobial resistance (AMR) [...] Full article
(This article belongs to the Special Issue Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients)

Research

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12 pages, 878 KiB  
Article
Antibiotic Choices for Pediatric Periorbital Cellulitis—A 20-Year Retrospective Study from Taiwan
by En-Jie Shih, Jui-Kuang Chen, Pei-Jhen Tsai, Muh-Chiou Lin and Youn-Shen Bee
Antibiotics 2022, 11(10), 1288; https://doi.org/10.3390/antibiotics11101288 - 21 Sep 2022
Cited by 3 | Viewed by 2418
Abstract
The delayed treatment of pediatric periorbital cellulitis may have severe consequences. In addition, the antibiotic efficacy against causative bacteria may change over time, and it is important to understand the appropriate antibiotic options for effective treatment in pediatric patients. We compared the changes [...] Read more.
The delayed treatment of pediatric periorbital cellulitis may have severe consequences. In addition, the antibiotic efficacy against causative bacteria may change over time, and it is important to understand the appropriate antibiotic options for effective treatment in pediatric patients. We compared the changes in cultured bacteria and drug susceptibility tests between two decades, 2010–2019 and 2000–2009, to establish antibiotics for empirical use. The patient characteristics, etiologies, culture sites, and isolated bacteria, and the antibiotic susceptibility tests of the admitted pediatric patients (n = 207) diagnosed with preseptal and orbital cellulitis during 2000 to 2019, were recorded. Insect/animal bites (p = 0.084) showed an increasing trend, and sinusitis (p = 0.016) showed a significant decrease in the past decades. The most common bacteria were Staphylococcus aureus, and methicillin-resistant S. aureus (MRSA) infections increased in recent decades (p = 0.01). Moreover, we found that vancomycin was ideal for MRSA infections. The decreasing efficacy of oxacillin correlates with the increasing proportion of MRSA in pediatric periorbital cellulitis. Our study thus offers antibiotic choices against the most common isolates that can be administered before culture results are available. Full article
(This article belongs to the Special Issue Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients)
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8 pages, 901 KiB  
Article
Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste
by Tessa Oakley, Brandon Le, Virginia da Conceicao, Ian Marr, Carolina Maia, Messias Soares, Joana Correia Belo, Nevio Sarmento, Endang da Silva, Salvador Amaral, Susana Vaz Nery, Sarah Lynar, Joshua R. Francis and Jennifer Yan
Antibiotics 2022, 11(9), 1262; https://doi.org/10.3390/antibiotics11091262 - 16 Sep 2022
Cited by 2 | Viewed by 1609
Abstract
Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such [...] Read more.
Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2–26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8–10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24–0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01–0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance. Full article
(This article belongs to the Special Issue Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients)
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9 pages, 1108 KiB  
Article
Macrolide versus Non-Macrolide in Combination with Steroids for the Treatment of Lobar or Segmental Mycoplasma pneumoniae Pneumonia Unresponsive to Initial Macrolide Monotherapy
by Eunha Bae, Ye Ji Kim, Hyun Mi Kang, Dae Chul Jeong and Jin Han Kang
Antibiotics 2022, 11(9), 1233; https://doi.org/10.3390/antibiotics11091233 - 10 Sep 2022
Cited by 3 | Viewed by 1895
Abstract
In the last few decades, macrolide-resistant Mycoplasma pneumoniae (MRMP) has been increasing in proportion. This study aimed to evaluate the treatment outcomes of children with lobar or segmental MP pneumonia unresponsive to the initial 3–5-day macrolide therapy, who then switched to either a [...] Read more.
In the last few decades, macrolide-resistant Mycoplasma pneumoniae (MRMP) has been increasing in proportion. This study aimed to evaluate the treatment outcomes of children with lobar or segmental MP pneumonia unresponsive to the initial 3–5-day macrolide therapy, who then switched to either a non-macrolide, macrolide + steroid, or a non-macrolide + steroid regimen, according to the 2019 KSPID and KAPARD guideline during the 2019–2020 Mycoplasma epidemic in South Korea. A total of 190 patients <18 years old were admitted during the study period for MP lobar or segmental pneumonia, and 16.8% (n = 32/190) were responsive to the initial macrolide monotherapy, whereas 83.2% (158/190) were refractory. The median age of the patients was 7 (interquartile range [IQR], 5–9) years old and 46.2% (n = 73/158) were male. The overall treatment success rates of non-macrolide, macrolide + steroid, and non-macrolide + steroid groups were 46.2%, 80.8%, and 100.0%, respectively. Patients in the non-macrolide + steroid group had the shortest fever duration after a regimen change of 1 (IQR, 0–3) day compared with patients in the non-macrolide group and macrolide + steroid group; 2 (IQR, 1–4) days and 2 (IQR, 1–3.3) days (p = 0.004), respectively. Follow-up CRP (ß, 0.169; CI, 0.050–0.287; p = 0.006), macrolide + steroid therapy (ß, −1.694; CI, −2.463–−0.925; p < 0.001), and non-macrolide+ steroid therapy (ß, −2.224; CI, −3.321–−1.127; p < 0.001) were shown to be significantly associated with the duration of fever after admission. To conclude, in patients with severe MP pneumonia that failed to respond to the initial macrolide therapy, a non-macrolide + steroid had the highest treatment success rate and a shorter duration of fever. Full article
(This article belongs to the Special Issue Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients)
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Review

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13 pages, 1339 KiB  
Review
Antimicrobial Stewardship Strategies Including Point-of-Care Testing (POCT) for Pediatric Patients with Upper-Respiratory-Tract Infections in Primary Care: A Systematic Review of Economic Evaluations
by Costanza Vicentini, Lorenzo Vola, Christian Previti, Valerio Brescia, Francesca Dal Mas, Carla Maria Zotti and Fabrizio Bert
Antibiotics 2022, 11(8), 1139; https://doi.org/10.3390/antibiotics11081139 - 22 Aug 2022
Cited by 4 | Viewed by 1996
Abstract
Upper-respiratory-tract infections (URTIs) are among the main causes of antibiotic prescriptions in pediatric patients. Over one-third of all antibiotic prescriptions for URTIs in children are estimated to be inappropriate, as the majority of URTIs are caused by viral agents. Several strategies, including clinical [...] Read more.
Upper-respiratory-tract infections (URTIs) are among the main causes of antibiotic prescriptions in pediatric patients. Over one-third of all antibiotic prescriptions for URTIs in children are estimated to be inappropriate, as the majority of URTIs are caused by viral agents. Several strategies, including clinical scoring algorithms and different point-of-care tests (POCTs) have been developed to help discriminate bacterial from viral URTIs in the outpatient clinical setting. A systematic review of the literature was conducted following PRISMA guidelines with the objective of summarizing evidence from health–economic evaluations on the use of POCT for URTIs in pediatric outpatients. A total of 3375 records identified from four databases and other sources were screened, of which 8 met the inclusion criteria. Four studies were classified as being of high reporting quality, and three were of medium quality. Five out of eight studies concluded in favor of strategies that included POCTs, with an additional study finding several POCTs to be cost-effective compared to usual care but over an acceptable WTP threshold. This review found POCT could be a valuable tool for antimicrobial stewardship strategies targeted towards childhood URTIs in primary care. Full article
(This article belongs to the Special Issue Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients)
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Other

22 pages, 1193 KiB  
Systematic Review
Therapeutic Options and Outcomes for the Treatment of Children with Gram-Positive Bacteria with Resistances of Concern: A Systematic Review
by Lorenzo Chiusaroli, Cecilia Liberati, Luigi Rulli, Elisa Barbieri, Marica De Pieri, Costanza Di Chiara, Daniele Mengato, Carlo Giaquinto and Daniele Donà
Antibiotics 2023, 12(2), 261; https://doi.org/10.3390/antibiotics12020261 - 28 Jan 2023
Cited by 4 | Viewed by 1900
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative Staphylococci (MR-CoNS), and vancomycin-resistant Enterococci (VRE) are increasing worldwide and represent a threat for the limited treatment options in pediatric patients and neonates compared to adults. Recommendations in pediatrics are mainly extrapolated from adults’ studies. Methods: [...] Read more.
Background: Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative Staphylococci (MR-CoNS), and vancomycin-resistant Enterococci (VRE) are increasing worldwide and represent a threat for the limited treatment options in pediatric patients and neonates compared to adults. Recommendations in pediatrics are mainly extrapolated from adults’ studies. Methods: A literature search for the treatment of these pathogens in children (<18 years old) was conducted in Embase, MEDLINE, and Cochrane Library. Studies reporting data on single-patient-level outcomes related to a specific antibiotic treatment for multidrug resistant (MDR) Gram-positive bacterial infection in children were included. Studies reporting data from adults and children were included if single-pediatric-level information could be identified (PROSPERO registration: CRD42022383867). Results: The search identified 11,740 studies (since January 2000), of which 48 fulfilled both the inclusion and the exclusion criteria and were included in the analysis: 29 for MRSA, 20 for VRE, and seven for MR-CoNS. Most studies were retrospective studies. Vancomycin was mainly used as a comparator, while linezolid and daptomycin were the most studied antimicrobials showing good efficacy. Conclusions: Linezolid showed a safety and efficacy profile in a neonatal setting; daptomycin is increasingly used for MRSA, but the evidence is scarce for VRE. Full article
(This article belongs to the Special Issue Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients)
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15 pages, 559 KiB  
Systematic Review
Antibiotics Self Medication among Children: A Systematic Review
by Fabrizio Bert, Christian Previti, Francesco Calabrese, Giacomo Scaioli and Roberta Siliquini
Antibiotics 2022, 11(11), 1583; https://doi.org/10.3390/antibiotics11111583 - 09 Nov 2022
Cited by 17 | Viewed by 3228
Abstract
The phenomenon of bacterial antimicrobial resistance (AMR) is a rapidly growing global problem. Overuse and misuse of antibiotics as well as self-prescription are among the most important causes contributing to the growth of antibiotic resistance in humans. This systematic review describes the phenomenon [...] Read more.
The phenomenon of bacterial antimicrobial resistance (AMR) is a rapidly growing global problem. Overuse and misuse of antibiotics as well as self-prescription are among the most important causes contributing to the growth of antibiotic resistance in humans. This systematic review describes the phenomenon of antibiotics self-medication (ASM) in children. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist by searching PubMed, Scopus, and Web of Science until July 2022. Published English language studies containing information regarding parents knowledge, attitudes, and behaviors in self-administration of antibiotics in children were included. A total of 702 articles were identified, and 57 were selected. A higher prevalence of ASM among children was found in the Middle-East (34%), Africa (22%), Asia (20%) and South America (17%), while the lowest prevalence was found in Europe (8%). High distance from hospital, and low income, such as having more than one child, are related with an increased risk of ASM in children. Fever and cough can also promote the misuse of antibiotics by parents. A greater attention to the regulation of the sale of antimicrobial drugs can certainly limit the risk of self-medicating behavior. Full article
(This article belongs to the Special Issue Antibiotic Prescribing and Antimicrobial Resistance Patterns in Pediatric Patients)
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