Comparative Analysis of Antibiotic Consumption Among Hospitalized Children in Mostly Common Surgical Cases. Summary of the Doctoral Thesis

Abstract

There has been a lot of discussions about the rational use of antibiotics (AB) because if they are used incorrectly it is possible for them to become a risk factor for developing resistant bacteria. Also, in this case they could cause extra costs for both hospitals and patients. Although AB are among the most common medicines given to children there are not enough researches completed, which would focus on this particular patient group. There is an urgent need to change the prescribing practice for children in general and surgical prophylaxis in particular by improving antimicrobial stewardship and identification of the factors, which have the biggest influence on antimicrobial prescribing. Off-label use of AB in children and adolescents is common, as well as dosage errors – especially in children under 12 years of age. The study “Comparative analysis of antibiotic consumption among hospitalized children in mostly common surgical cases” focuses on analyzing paediatric AB prescribing patterns at the University Childrens’Hospital (UCH) in general and the use of AB in mostly common surgical diseases (acute appendicitis, mesadenitis and injuries of upper and lower extremities) at the Paediatric Surgery Clinic of the UCH in particular. AB consumption tendencies were analysed by using defined daily dosage method in reference of 2006–2013 and six point prevalence surveys (PPS) which were completed in May and November of 2011, 2012 and 2013. The use of AB in mostly common surgical diseases was analysed in patients hospitalized in 2011–2013 and 2001–2003. AB dosages and off-label use of AB were analyzed for most commonly used AB at the Paediatric Surgery Clinic. This study included analysis of a total of 520 patients in 2011–2013 and 773 patients in 2001–2003 with acute appendicitis, 181 patient 2011–2013 and 399 patients in 2001-2003 with mesadenitis and 2186 patients in 2011–2013 and 2050 patients in 2001–2003 with injuries of upper and lower extremities. The study results showed that the spectrum of most frequently used AB had changed. The use of penicillins had decreased, but the use of high risk AB, such as 3rd generation cephalosporins in general and ceftriaxone in particular, had increased. The frequent use of these high risk AB can result in the increase of resistant bacterial strains. In 2011–2013 there were more cases with incorrect surgical prophylaxis (too early or too late, and AB were also used for the longer period of time than it is recommended by the guidelines and recommendations) in patients with acute appendicitis than it was in 2001–2003. There were also many surgeries where patients did not receive prophylaxis, although it was recommended by the guidelines (both patients with acute appendicitis and patients with injuries of upper and lower extremities). AB doses were indicated as incorrect more often in patients under 12 years of age. There were many cases when the reason on the AB use was not written in medical records. It was found more often in patients with acute appendicitis and mesadenitis. The off-label use of AB was observed in all surgical patient groups, which were included in this study (with acute appendicitis, mesadenitis and injuries of upper and lower extremities). Until now in Latvia AB consumption in hospitalized children was never analyzed separately from the data related to the adults. The same situation was with AB use in surgical prophylaxis and treatment of hospitalized children in most common surgical cases. This study emphasizes the need for improvement of the AB use in the UCH. The data presented here can be used to improve AB usage both in the UCH and paediatric wards in other Latvian hospitals.