Promoting Prudent Antibiotic Use in Children and Trainees

Reviewed by: Joseph Ting, MBBS MPH; University of British Columbia and Rupak Datta, MD PhD; Yale School of Medicine

According to two recent international studies, there is a need to improve antibiotic use in pediatric inpatients and antibiotic-associated curricula in medical school graduates and young specialists.

In a recent study published in Pediatric Infectious Diseases Journal, researchers conducted one-day hospital-wide point prevalence surveys 8 times between 2003 and 2017 at Astrid Lindgren Children’s Hospital in Sweden.  Children < 17 years-old were included.  Medical records were evaluated for risk factors, indications for treatment, and antimicrobial prescriptions.  Among 946 pediatric inpatients, 36% (336/946) received an antimicrobial prescription. Over the study period, the total number of prescriptions (p = 0.031) and proportion of patients receiving prophylactic antimicrobial therapy (11% to 43%, p=0.005) increased.  However, the proportion of total patients treated, and rate of hospital-acquired infections remained unchanged.  The most common indications for antimicrobial therapy included sepsis and fever of unknown origin followed by intra-abdominal infections and pneumonia.  The most common antimicrobial prescriptions included cephalosporins during the early study period and piperacillin-tazobactam in 2017.  Notably, the hospital case mix changed with an increasing number of patients with risk factors for infectious diseases over time.  The investigators conclude that antimicrobial use changed over time, primarily due to increased prophylactic use in at-risk patients. Antimicrobial stewardship programs and increased availability of guidelines may improve antimicrobial therapy in children.  These findings add to the limited published data on antimicrobial use among pediatric inpatients.

In the Journal of Antimicrobial Chemotherapy, a European study group conducted an international web-based exploratory survey to evaluate the practices, attitudes and beliefs on antibiotic use and resistance in young doctors from different specialties.  Young doctors included medical school graduates and early specialists that have not taken specialty board examinations.  Principal component analysis and bivariate and multivariate analysis of variance were used to investigate differences between young doctors according to their country of specialization, specialty, year of training, and gender.  Overall, the survey was completed by 2842 young doctors from 29 countries and 61 specialties.  Most respondents were from Spain (n=818, 34.6%), France (n=653, 27.6%), and Slovenia (n=444, 18.8%) and specialized in family medicine (n=682, 28.8%), internal medicine (n=637, 26.9%), and surgery (n=204, 8.6%).  Notably, 54.2% of young doctors prescribed antibiotics predominantly as instructed by a mentor.  Associations between the variability of responses and the country of origin were observed across most questions, followed by variability according to specialty.  Very few differences were associated with year of training and gender.  Principal component analysis revealed five dimensions of antibiotic prescribing culture: self-assessment of knowledge, consideration of side effects, perception of prescription patterns, consideration of patient sickness and perception of antibiotic resistance. Only the country of specialization (partial η2 0.010–0.111) and the type of specialization (0.013–0.032) significantly affected all five dimensions (P < 0.01).  The authors conclude that the use of competencies in antibiotic use in all specialty curricula and international harmonization of training may improve antibiotic prescribing in young doctors.


Luthander J, Bennet R, Nilsson A, Eriksson M. “Antimicrobial Use in a Swedish Pediatric Hospital Results From Eight Point-prevalence Surveys Over a 15-Year Period (2003–2017)”. Pediatr Infect Dis J 2019; 38: 929–933. 

Beovic B, Dousak M, Pulcini C, et al. Young doctors’ perspectives on antibiotic use and resistance: a multinational and inter-specialty cross-sectional European Society of Clinical Microbiology and Infectious Diseases (ESCMID) survey. The Journal of antimicrobial chemotherapy. Sep 3 2019. 

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