Antimicrobial Stewardship in Pediatric Emergency Medicine: A Narrative Exploration of Antibiotic Overprescribing, Stewardship Interventions, and Performance Metrics

Antibiotic overprescribing is prevalent in pediatric emergency medicine, influenced by clinician–caregiver dynamics and diagnostic uncertainties, and poses substantial risks such as increasing antibacterial resistance, adverse drug reactions, and increased healthcare expenditures. While antimicrobia...

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Bibliographic Details
Published in:Children (Basel) Vol. 11; no. 3; p. 276
Main Authors: Meesters, Kevin, Buonsenso, Danilo
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 23.02.2024
MDPI
Subjects:
Antibacterial agents
Antibiotics
Antigens
Antimicrobial agents
antimicrobial stewardship
Bacterial infections
Bias
biomarkers
C-reactive protein
Caregivers
Children & youth
Decision making
Development and progression
Diagnosis
Ear diseases
education
Emergency medical care
Emergency medicine
Fever
guidelines
Health care
Infection
Infections
Influenza
Medical care
Medical care, Cost of
Pediatric emergencies
pediatric emergency medicine
Pediatrics
Prescription writing
Prescriptions
Primary care
Quality management
rapid antigen detection tests
Review
Viral infections
feedback
pediatric emergency medicine
education
antimicrobial stewardship
defined daily dose
biomarkers
days of therapy
guidelines
rapid antigen detection tests
ISSN:2227-9067, 2227-9067
Online Access:Get full text
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Summary:Antibiotic overprescribing is prevalent in pediatric emergency medicine, influenced by clinician–caregiver dynamics and diagnostic uncertainties, and poses substantial risks such as increasing antibacterial resistance, adverse drug reactions, and increased healthcare expenditures. While antimicrobial stewardship programs have proven effective in optimizing antibiotic use within inpatient healthcare settings, their implementation in pediatric emergency medicine presents specific challenges. Existing biomarkers like white blood cell count, C-reactive protein, procalcitonin, and presepsin have limitations in their ability to distinguish (serious) bacterial infections from other etiologies of fever. Furthermore, rapid antigen detection tests and guidelines aimed at guiding antibiotic prescriptions for children have not consistently reduced unnecessary antibiotic use. To improve antibiotic prescribing practices, potential strategies include the utilization of decision support tools, audit and feedback, establishing follow-up procedures, implementing safety netting systems, and delivering comprehensive training and supervision. Notably, host genome signatures have also gained attention for their potential to facilitate rapid and precise diagnoses of inflammatory syndromes. Standardized metrics are crucial for evaluating antimicrobial use within pediatric healthcare settings, enabling the establishment of benchmarks for assessing antibiotic utilization, quality enhancement initiatives, and research endeavors.
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ISSN:2227-9067
2227-9067
DOI:10.3390/children11030276