Issue: October 2011
October 01, 2011
2 min read

Inappropriate antibiotic use continues in children’s hospitals

51st ICAAC

Issue: October 2011
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact

CHICAGO — Inappropriate use of antibiotics reached nearly 20% with vancomycin in one children’s hospital, according to findings reported here at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy

The study was conducted to quantify pediatric antimicrobial use in patient days of therapy per 1,000 patient-days (DOT/1,000). Antibiotic utilization rates for several antimicrobials increased significantly during the study period.

“Nearly 20% of vancomycin and 10% of cefepime courses in the pediatric intensive care unit were inappropriate, largely due to failure to stop or deescalate therapy, suggesting targets for future stewardship interventions,” the investigators wrote.

To attempt to identify targets for antimicrobial stewardship interventions, Emily R. Levy, MD, and colleagues examined trends in utilization rates for 48 different antimicrobials during 2007-2010, as well as appropriateness of vancomycin and cefepime use in 2010.

Emily R. Levy
Emily R.

“There’s a lot more work to be done in the antimicrobial stewardship field,” Levy, who is currently a pediatric resident at the University of California at San Francisco, told Infectious Diseases in Children. “Despite programs that are hospital-wide in several children’s hospitals, we are still seeing significant amounts of inappropriate use, especially with vancomycin and cefepime.”

The investigators calculated hospital and unit-specific rates for 32 antibacterial drugs, seven antiviral drugs and nine antifungal drugs.

Of 17,242 pediatric inpatients, 9,880 (57%) received an antimicrobial during their hospitalization. The antimicrobials used most frequently in 2010 were cefazolin (97.8 DOT/1,000), vancomycin (97.1 DOT/1,000), fluconazole (76.4 DOT/1,000), piperacillin-tazobactam (70.7 DOT/1,000), cefepime (67.6 DOT/1,000), trimethoprim-sulfamethoxazole (TMP-SMX) (66.3 DOT/1,000) and ampicillin (60.8 DOT/1,000).

Between 2007 and 2010, utilization rates increased by more than 45% for fluconazole, caspofungin, piperacillin-tazobactam, cefepime, TMP-SMX. Rates increased more than 15% for vancomycin. Utilization rates decreased by more than 25% for metronidazole, ceftazidime, and gentamicin, and by more than 15% for ampicillin.

Thirty-five of 308 (11.4%) vancomycin courses and 13 of 215 (6.0%) cefepime courses were identified as inappropriate. Inappropriateness was greater in the pediatric intensive care unit than on the rest of the pediatric ward for vancomycin (17.8% vs. 6.4%, P=.001) and for cefepime (9.2 vs. 3.9%, P=.142). Greater inappropriate use also was observed in the surgical ward compared with medical services (20.5% vs. 8.0%, P=.001 for vancomycin; 19.4% vs 3.4%, P=.001 for cefepime).

Levy and colleagues concluded that antibiotic courses were inappropriate most commonly due to failure to discontinue or deescalate therapy (28 of 35, 80% for vancomycin; 9 of 13, 69% for cefepime). — by Cassandra A. Richards

Disclosure: Dr. Levy reports no relevant financial disclosures.

For more information:

  • Levy ER. #G3-175. Trends in Antimicrobial Prescribing at an Academic Children’s Hospital, 2007-2010. Presented at: 51st ICAAC. Sept. 17-20, 2011. Chicago.
Twitter Follow the on Twitter.