Policy brief: Optimising antimicrobial usage in paediatric inpatient hospital settings

Authors

  • J Cloete Department of Paediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa and Maternal and Infant Health Care Strategies Research Unit Centre, University of Pretoria, Pretoria, South Africa
  • M Karsas Department of Paediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa; and Maternal and Infant Health Care Strategies Research Unit Centre, University of Pretoria, South Africa
  • T Chetty HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa. Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
  • A Pillay Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
  • M Archary Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
  • D Moore Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council Vaccine and Infectious Diseases Analytics (VIDA) Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  • T Reddy Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa; School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
  • Y Balakrishna Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
  • F Nakwa Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • R Lancaster Affordable Medicines Directorate, National Department of Health, Pretoria, South Africa
  • A Goga HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa; Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
  • P Jeena Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa; Department of Paediatrics and Child Health, Inkosi Albert Luthuli Central Hospital, Durban, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i4.1296

Keywords:

Antimicrobial use, hospital acquired infection, paediatric antimicrobial use, paediatric hospital acquired infection, antimicrobial resistance, paediatric antimicrobial resistance

Abstract

Antimicrobial resistance (AMR) poses a global threat, partly fueled by antimicrobial overuse. Paediatric inpatients are particularly vulnerable to infections, leading to high antimicrobial consumption. In low-to-middle income countries (LMICs) like South Africa, research on antimicrobial usage for neonatal and paediatric healthcare-associated infections (HAI) is limited. This cross-sectional study evaluated antimicrobial usage in three academic public sector hospitals in South Africa to improve appropriateness. 22.9% of hospitalised children received at least one prescribed antimicrobial, with neonates, infants, and adolescents having higher prescription rates for HAIs. Common antimicrobials prescribed included beta-lactamase sensitive penicillin, aminoglycosides, and carbapenems. Antimicrobial selection aligned with the WHO AWaRe classification system. HIV infection did not emerge as a risk factor for HAIs or excessive antimicrobial usage. The policy brief recommends several strategies, summarized by the acronym 'PRACTICE,' to optimize antimicrobial prescribing practices. These include implementing standardized policies for empiric antimicrobial use, routine review of antimicrobial therapy, age-specific antimicrobial stewardship programs, and continued collaborative efforts and research. Individualized treatment plans, improved infection prevention and control measures, ongoing surveillance, and exploring electronic technology for antimicrobial stewardship are also crucial. Addressing antimicrobial usage is imperative to combat the growing threat of AMR and improve patient outcomes in LMICs like South Africa.

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Published

2024-04-18

Issue

Vol. 114 No. 4 (2024)

Section

In Practice

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Copyright (c) 2024 J Cloete, M Karsas, T Chetty, A Pillay, M Archary, D Moore, T Reddy, Y Balakrishna, F Nakwa, R Lancaster, A Goga, P Jeena

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How to Cite

1.
Cloete J, Karsas M, Chetty T, Pillay A, Archary M, Moore D, et al. Policy brief: Optimising antimicrobial usage in paediatric inpatient hospital settings. S Afr Med J [Internet]. 2024 Apr. 18 [cited 2025 Mar. 23];114(4):e1296. Available from: https://samajournals.co.za/index.php/samj/article/view/1296