Findings published in the Journal of the Pediatric Infectious Diseases Society showed that nearly 2% of children admitted to 32 children’s hospitals in the United States received at least one antimicrobial agent for conditions that were not infection-related.
“There really hasn’t been a detailed examination of the prevalence of noninfectious antimicrobial prescribing among inpatients in the past,” Preeti Jaggi, MD, acting associate professor of pediatric infectious diseases at Emory University and director of the antimicrobial stewardship program at Children’s Healthcare of Atlanta, told Infectious Diseases in Children. “As far as I know, this is the first U.S. study to examine the prevalence of this type of prescribing.”
Jaggi colleagues conducted a cross-sectional point-prevalence survey in which infectious disease physicians and pharmacists at 32 pediatric inpatient facilities completed surveys for 2 weeks between June 2016 and December 2017.
During the study period, 35,378 children aged younger than 18 years were treated in the facilities. More than one-third (37.3%) received at least one antimicrobial agent. Of those with noninfectious indications, 627 (1.7%) received antimicrobial agents, accounting for 4.7% of all antimicrobial prescriptions.
Prescribing practices varied by hospital, with rates ranging from 0% to 10.1%. Patients in medical wards received most prescriptions (61.4%), followed by non-neonatal ICUs (19.9%), NICUs (9.2%) and surgical wards (7.7%).
The most commonly reported noninfectious reasons for antimicrobial use included gastrointestinal prokinesis (67.4%). Antimicrobials also were commonly used for anti-inflammatory properties (17.5%) and small bowel bacterial overgrowth (5.5%). Providers most often prescribed erythromycin (63.1%), azithromycin (19.9%), amoxicillin-clavulanate (5.5%), metronidazole (5.2%), hydroxychloroquine (2.8%) and amantadine (1.7%).
“In the future, antimicrobial stewardship efforts need to involve not only infectious disease specialists, but also other subspecialists so we can develop guidelines for use of these agents,” Jaggi said. “It would be helpful to have, for instance, a multidisciplinary panel to review both the risks and benefits of prolonged erythromycin use, which was the drug most commonly used for non-infectious reasons in this study.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.