Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK.
The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance.



We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates.



A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam.



We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.
NIHR Health Protection Research Unit Antimicrobial Resistance and Healthcare Associated Infection-Department of Primary Care and Public Health, Imperial College London, London, UK.
Myriam
M
Gharbi
Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK.
Katja
K
Doerholt
Institute for Infection and Immunity-Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK.
Stefania
S
Vergnano
Institute for Infection and Immunity-Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK.
Julia Anna
JA
Bielicki
Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Stéphane
S
Paulus
Department of General Paediatrics, Evelina London Children's Hospital, London, UK.
Esse
E
Menson
Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Andrew
A
Riordan
Department of Infectious Diseases, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK.
Hermione
H
Lyall
Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK.
Sanjay Valabh
SV
Patel
Paediatric Infectious Disease and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Bristol, UK.
Jolanta
J
Bernatoniene
Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium.
Ann
A
Versporten
National Public Health Service for Wales, Cardiff, UK.
Maggie
M
Heginbothom
Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium.
Herman
H
Goossens
Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK.|Institute for Infection and Immunity-Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK.
Mike
M
Sharland
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004352:Drug Resistance, Microbial; D004363:Drug Utilization; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D007223:Infant; D008297:Male; D010372:Pediatrics; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D010818:Practice Patterns, Physicians'; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
Antimicrobials resistance; Benchmarking; Paediatric practice; Quality indicators; Surveillance