title: A review of antimicrobial control strategies in hospitalized and ambulatory pediatric populations.
abstract: Antimicrobial resistance is a growing crisis in healthcare. Various antimicrobial stewardship strategies have been used to control antibiotic use in efforts to reduce antibiotic resistance. We conducted a systematic review of antimicrobial stewardship programs in pediatric settings. Twenty-eight published studies met inclusion criteria. The majority (21 of 28) of studies had positive outcomes, but only 6 measured the impact of interventions on antimicrobial resistance. Prescriber education for a specific diagnosis (eg, otitis media) was the most effective intervention in the outpatient setting. Ancillary laboratory tests (eg, rapid diagnostic assays for viral pathogens) were most effective in the inpatient setting. Most studies had moderate to high risk of bias, mainly because of selection bias, inadequate preintervention data for time series analysis, and contamination between treatment groups. To date, there are a limited number of studies assessing antimicrobial stewardship in pediatric settings and these have heterogeneous study designs. Thus, it is difficult to determine the most effective interventions. Future studies should be designed to overcome the biases encountered in current publications.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, New York-Presbyterian Hospital, New York, NY 10032, USA. sap9013@nyp.org
authors.forename: Sameer J
authors.initials: SJ
authors.lastname: Patel
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Kubin
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D006291:Health Policy; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016134:Organizational Policy
chemical_list: D000900:Anti-Bacterial Agents