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Italian Journal of Pediatrics
Published in: Italian Journal of Pediatrics 1/2017

Open Access 01-12-2017 | Research

Monitoring adherence to guidelines of antibiotic use in pediatric pneumonia: the MAREA study

Authors: Pasquale Di Pietro, Ornella Della Casa Alberighi, Michela Silvestri, Maria Angela Tosca, Anna Ruocco, Giorgio Conforti, Giovanni A. Rossi, Elio Castagnola, Maria Caterina Merlano, Simona Zappettini, Salvatore Renna, the Pediatric Ligurian Network MAREA network

Published in: Italian Journal of Pediatrics | Issue 1/2017

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Abstract

Background

Children are the most vulnerable population exposed to the use of antibiotics often incorrectly prescribed for the treatment of infections really due to viruses rather than to bacteria. We designed the MAREA study which consisted of two different studies: i) a surveillance study to monitor the safety/efficacy of the antibiotics for the treatment of pneumonia (CAP), pharyngotonsillitis and acute otitis media in children younger than 14 yrs old, living in Liguria, North-West Italy and ii) a pre−/post-interventional study to evaluate the appropriateness of antibiotic prescription for the treatment these infections. In this paper, we show only results of the appropriateness study about the antibiotic prescription for the treatment of pneumonia.

Methods

Patients included in this study met the following inclusion criteria: i) admission to the Emergency/Inpatient Dpt/outpatient clinic of primary care pediatricians for pneumonia requiring antibiotics, ii) informed written consent. The practice of prescribing antibiotics was evaluated before-and-after a 1 day-educational intervention on International/National recommendations.

Results

Global adherence to guidelines was fulfilled in 45%: main reason for discordance was duration (shorter than recommended). Macrolide monotherapy and cephalosporins were highly prescribed; ampicillin/amoxicillin use was limited. 61% of patients received >1 antibiotic; parenteral route was used in 33%. After intervention, i) in all CAP, cephalosporin prescription decreased (−23%) and the inappropriate macrolide prescriptions was halved and, ii) in not hospitalized CAP (notH-CAP), macrolides were prescribed less frequently (−25%) and global adherence to guidelines improved (+39%); and iii) in H-CAP antibiotic choice appropriateness increase.

Conclusion

Prescribing practices were sufficiently appropriate but widespread preference for multidrug empirical regimens or macrolide in monotherapy deserve closer investigation.
Literature
1.
Bradley CP. Decision making and prescribing patterns--a literature review. Fam Pract. 1991;8(3):276–87.CrossRefPubMed
2.
3.
NICE NICE Short Clinical Guidelines Technical Team, 2008.
4.
Bronzwaer SL, Cars O, Buchholz U, Molstad S, Goettsch W, Veldhuijzen IK, et al. A european study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis. 2002;8(3):278–82.CrossRefPubMedPubMedCentral
5.
Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British thoracic society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66(Suppl 2):ii1–23.CrossRefPubMed
6.
Weissman J, Besser RE. Promoting appropriate antibiotic use for pediatric patients: a social ecological framework. Semin Pediatr Infect Dis. 2004;15(1):41–51.CrossRefPubMed
7.
de Bie S, Kaguelidou F, Verhamme KM, De Ridder M, Picelli G, Straus SM, et al. Using prescription patterns in primary care to derive new quality indicators for childhood community antibiotic prescribing. Pediatr Infect Dis J. 2016;35(12):1317–23.CrossRefPubMed
8.
Esposito S, Cohen R, Domingo JD, Pecurariu OF, Greenberg D, Heininger U, et al. Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat? Pediatr Infect Dis J. 2012;31(6):e78–85.CrossRefPubMed
9.
Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096.CrossRefPubMed
10.
van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, et al. Antimicrobial drug use and resistance in europe. Emerg Infect Dis. 2008;14(11):1722–30.CrossRefPubMedPubMedCentral
11.
Andrews T, Thompson M, Buckley DI, Heneghan C, Deyo R, Redmond N, et al. Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis. PLoS One. 2012;7(1):e30334.CrossRefPubMedPubMedCentral
12.
Perz JF, Craig AS, Coffey CS, Jorgensen DM, Mitchel E, Hall S, et al. Changes in antibiotic prescribing for children after a community-wide campaign. JAMA. 2002;287(23):3103–9.CrossRefPubMed
13.
Piovani D, Clavenna A, Sequi M, Cartabia M, Bortolotti A, Fortino I, et al. Reducing the costs of paediatric antibiotic prescribing in the community by implementing guideline recommendations. J Clin Pharm Ther. 2013;38(5):373–8.CrossRefPubMed
14.
Weddle G, Goldman J, Myers A, Newland J. Impact of an educational intervention to improve antibiotic prescribing for nurse practitioners in a pediatric urgent care center. J Pediatr Health Care. 2017;31(2):184–8.CrossRefPubMed
15.
Ciofi degli Atti ML, Massari M, Bella A, Boccia D, Filia A, Salmaso S, et al. Clinical, social and relational determinants of paediatric ambulatory drug prescriptions due to respiratory tract infections in italy. Eur J Clin Pharmacol. 2006;62(12):1055–64.CrossRefPubMed
16.
Nash DR, Harman J, Wald ER, Kelleher KJ. Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Arch Pediatr Adolesc Med. 2002;156(11):1114–9.CrossRefPubMed
17.
Boonstra E, Lindbaek M, Ngome E. Adherence to management guidelines in acute respiratory infections and diarrhoea in children under 5 years old in primary health care in botswana. Int J Qual Health Care. 2005;17(3):221–7.CrossRefPubMed
18.
Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996;43(1):56–62.PubMed
19.
Mainous AG 3rd, Hueston WJ, Love MM. Antibiotics for colds in children: who are the high prescribers? Arch Pediatr Adolesc Med. 1998;152(4):349–52.PubMed
20.
Mainous AG 3rd, Zoorob RJ, Oler MJ, Haynes DM. Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization. J Fam Pract. 1997;45(1):75–83.PubMed
21.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–65.CrossRefPubMed
22.
23.
Ciofi degli Atti M, Spila Alegiani S, Raschetti R, Arace P, Giusti A, Spiazzi R, et al. Surgical antibiotic prophylaxis in children: adherence to indication, choice of agent, timing, and duration. Eur J Clin Pharmacol. 2015;71(4):483–8.CrossRefPubMed
24.
Hodgson KA, Huynh J, Ibrahim LF, Sacks B, Golshevsky D, Layley M, et al. The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy. Arch Dis Child. 2016;101(10):886–93.CrossRefPubMed
25.
Mahdaviazad H, Masoompour SM, Askarian M. Iranian surgeons' compliance with the american society of health-system pharmacists guidelines: antibiotic prophylaxis in private versus teaching hospitals in shiraz, iran. J Infect Public Health. 2011;4(5–6):253–9.CrossRefPubMed
26.
Westphal JF, Jehl F, Javelot H, Nonnenmacher C. Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting. Pharmacoepidemiol Drug Saf. 2011;20(2):162–8.CrossRefPubMed
27.
Saleh EA, Schroeder DR, Hanson AC, Banerjee R. Guideline-concordant antibiotic prescribing for pediatric outpatients with otitis media, community-acquired pneumonia, and skin and soft tissue infections in a large multispecialty healthcare system. Clin Res Infect Dis. 2015;2(1):1010.PubMedPubMedCentral
28.
Kronman MP, Hersh AL, Feng R, Huang YS, Lee GE, Shah SS. Ambulatory visit rates and antibiotic prescribing for children with pneumonia, 1994-2007. Pediatrics. 2011;127(3):411–8.CrossRefPubMedPubMedCentral
29.
Boccia D, Alegiani SS, Pantosti A, Moro ML, Traversa G. The geographic relationship between the use of antimicrobial drugs and the pattern of resistance for streptococcus pneumoniae in italy. Eur J Clin Pharmacol. 2004;60(2):115–9.CrossRefPubMed
30.
Seppala H, Klaukka T, Vuopio-Varkila J, Muotiala A, Helenius H, Lager K, et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group a streptococci in finland. Finnish study group for antimicrobial resistance. N Engl J Med. 1997;337(7):441–6.CrossRefPubMed
31.
European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2014. Annual report of the European antimicrobial resistance surveillance network (EARS-net). Stockholm: ECDC; 2015.
32.
33.
Clavenna A, Bonati M. Differences in antibiotic prescribing in paediatric outpatients. Arch Dis Child. 2011;96(6):590–5.CrossRefPubMed
34.
De Luca M, Dona D, Montagnani C, Lo Vecchio A, Romanengo M, Tagliabue C, et al. Antibiotic prescriptions and prophylaxis in italian children. Is it time to change? Data from the ARPEC project. PLoS One. 2016;11(5):e0154662.CrossRefPubMedPubMedCentral
35.
Principi N, Esposito S. Emerging role of mycoplasma pneumoniae and chlamydia pneumoniae in paediatric respiratory-tract infections. Lancet Infect Dis. 2001;1(5):334–44.CrossRefPubMed
36.
Esposito S, Blasi F, Allegra L, Principi N, Mowgli Study Group. Use of antimicrobial agents for community-acquired lower respiratory tract infections in hospitalised children. Eur J Clin Microbiol Infect Dis. 2001;20(9):647–50.PubMed
37.
Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25–76.CrossRefPubMed
38.
39.
Neuman MI, Hall M, Hersh AL, Brogan TV, Parikh K, Newland JG, et al. Influence of hospital guidelines on management of children hospitalized with pneumonia. Pediatrics. 2012;130(5):e823–30.CrossRefPubMed
40.
Pellegrino P, Carnovale C, Cattaneo D, Perrone V, Antoniazzi S, Pozzi M, et al. Pharmacovigilance knowledge in family paediatricians. A survey study in italy. Health Policy. 2013;113(1–2):216–20.CrossRefPubMed
Metadata
Title
Monitoring adherence to guidelines of antibiotic use in pediatric pneumonia: the MAREA study
Authors
Pasquale Di Pietro
Ornella Della Casa Alberighi
Michela Silvestri
Maria Angela Tosca
Anna Ruocco
Giorgio Conforti
Giovanni A. Rossi
Elio Castagnola
Maria Caterina Merlano
Simona Zappettini
Salvatore Renna
the Pediatric Ligurian Network MAREA network
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Italian Journal of Pediatrics / Issue 1/2017
Electronic ISSN: 1824-7288
DOI
https://doi.org/10.1186/s13052-017-0432-2

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