title: Antibiotic Prescriptions and Prophylaxis in Italian Children. Is It Time to Change? Data from the ARPEC Project.
abstract: Antimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children's hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions.
  
  
  
  A 1-day PPS on antibiotic use in hospitalized neonates and children was performed in Italy between October and December 2012 as part of the Antibiotic Resistance and Prescribing in European Children project (ARPEC). Seven institutions in seven Italian cities were involved. The survey included all admitted patients less than 18 years of age present in the ward at 8:00 am on the day of the survey, who had at least one on-going antibiotic prescription. For all patients data about age, weight, underlying disease, antimicrobial agent, dose and indication for treatment were collected.
  
  
  
  The PPS was performed in 61 wards within 7 Italian institutions. A total of 899 patients were eligible and 349 (38.9%) had an on-going prescription for one or more antibiotics, with variable rates among the hospitals (25.7% - 53.8%). We describe antibiotic prescriptions separately in neonates (<30 days old) and children (> = 30 days to <18 years old). In the neonatal cohort, 62.8% received antibiotics for prophylaxis and only 37.2% on those on antibiotics were treated for infection. Penicillins and aminoglycosides were the most prescribed antibiotic classes. In the paediatric cohort, 64.4% of patients were receiving antibiotics for treatment of infections and 35.5% for prophylaxis. Third generation cephalosporins and penicillin plus inhibitors were the top two antibiotic classes. The main reason for prescribing antibiotic therapy in children was lower respiratory tract infections (LRTI), followed by febrile neutropenia/fever in oncologic patients, while, in neonates, sepsis was the most common indication for treatment. Focusing on prescriptions for LRTI, 43.3% of patients were treated with 3rd generation cephalosporins, followed by macrolides (26.9%), quinolones (16.4%) and carbapenems (14.9%) and 50.1% of LRTI cases were receiving more than one antibiotic. For neutropenic fever/fever in oncologic patients, the preferred antibiotics were penicillins with inhibitors (47.8%), followed by carbapenems (34.8%), aminoglycosides (26.1%) and glycopeptides (26.1%). Overall, the 60.9% of patients were treated with a combination therapy.
  
  
  
  Our study provides insight on the Italian situation in terms of antibiotic prescriptions in hospitalized neonates and children. An over-use of third generation cephalosporins both for prophylaxis and treatment was the most worrisome finding. A misuse and abuse of carbapenems and quinolones was also noted. Antibiotic stewardship programs should immediately identify feasible targets to monitor and modify the prescription patterns in children's hospital, also considering the continuous and alarming emergence of MDR bacteria.
authors.affiliation: Immunology and Infectious Diseases Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Maia
authors.identifier: 0000-0001-7549-3514
authors.initials: M
authors.lastname: De Luca
authors.affiliation: Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Donà
authors.affiliation: Paediatric Infectious Diseases Unit, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Montagnani
authors.affiliation: Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lo Vecchio
authors.affiliation: Acute Care and Emergency Department, G. Gaslini Children's Hospital, Genoa, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Romanengo
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Tagliabue
authors.affiliation: Paediatric Unit, Versilia Hospital, Lido di Camaiore, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Centenari
authors.affiliation: Immunology and Infectious Diseases Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: D'Argenio
authors.affiliation: Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lundin
authors.affiliation: Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
authors.affiliation: Paediatric Infectious Diseases Unit, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
authors.affiliation: Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Naples, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Infection and Immunity, Division of Clinical Sciences, St. Georges University of London, London, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Versporten
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.affiliation: Pediatric Unit, San Martino Hospital, Belluno, Italy.
authors.forename: Giangiacomo
authors.initials: G
authors.lastname: Nicolini
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents