Amanda Good is a certified pediatric NP and a family medicine nurse at Charles River Community Health, Boston. Rita Olans is an associate professor at the MGH Institute of Health Professions, Boston. Contact author: Amanda Good,
Am J Nurs. 2021 Nov 1;121(11):38-43. doi: 10.1097/01.NAJ.0000798052.41204.18.
With the rise of antibiotic resistance, antimicrobial stewardship programs can now be found in the ambulatory setting, where nearly 95% of antibiotic prescriptions originate. Judicious use of antibiotics is of particular importance to the ambulatory pediatric provider, as the annual antibiotic prescription rate is highest among children ages two and younger and inappropriate early-life antibiotic use is associated with elevated childhood risk of several medical conditions. While most ambulatory antibiotic stewardship programs have focused on shaping clinician behaviors to prevent unnecessary antibiotic prescribing, duration of antibiotic therapy has been found to be a critical, yet underexamined, facet of antibiotic use. In the past, duration of antibiotic therapy was largely based on convention and expert opinion, with little scientific evidence supporting many of the recommendations. Research suggests that many common pediatric infections such as acute otitis media, community-acquired pneumonia, streptococcal pharyngitis, and urinary tract infections can be effectively and safely treated with reduced courses of antibiotic therapy. In addition to reducing the incidence of antibiotic resistance, a shorter duration of antibiotic therapy may help prevent many adverse effects associated with antibiotic treatment. Current studies on the duration of antibiotic therapy, especially in pediatrics, are limited as they often rely on data extrapolated from adult studies that fail to consider the effects of age-related growth and development on both pharmacokinetics and pharmacodynamics. Future investigation into this topic is also limited by researchers' reliance on subsidies from pharmaceutical companies; clinicians' fear of undertreating infection; and hesitancy to deviate from current standards of care, even when such standards are not evidence based. Despite these challenges, the dangers of inappropriate antibiotic use in the pediatric population warrant further evaluation.
随着抗生素耐药性的出现，现在在门诊环境中也可以找到抗菌药物管理项目，近 95%的抗生素处方都来自这里。明智地使用抗生素对门诊儿科医生尤为重要，因为每年抗生素的处方率在 2 岁以下儿童中最高，而早期不适当的抗生素使用与儿童多种医疗条件的风险增加有关。虽然大多数门诊抗菌药物管理项目都集中在改变临床医生的行为以防止不必要的抗生素处方，但抗生素治疗的持续时间已被发现是抗生素使用的一个关键但尚未得到充分研究的方面。过去，抗生素治疗的持续时间在很大程度上基于传统和专家意见，几乎没有科学证据支持许多建议。研究表明，许多常见的儿科感染，如急性中耳炎、社区获得性肺炎、链球菌性咽炎和尿路感染，可以通过缩短抗生素治疗疗程得到有效和安全的治疗。除了减少抗生素耐药性的发生外，缩短抗生素治疗的持续时间还可能有助于预防与抗生素治疗相关的许多不良反应。目前关于抗生素治疗持续时间的研究，尤其是儿科研究，受到限制，因为它们通常依赖于从未能考虑年龄相关生长和发育对药代动力学和药效学影响的成人研究中推断的数据。由于研究人员依赖制药公司的补贴、临床医生担心治疗不足的感染以及不愿偏离当前的护理标准，即使这些标准没有证据支持，未来对这一主题的调查也受到限制。尽管存在这些挑战，但不适当的抗生素在儿科人群中的使用的危险仍需要进一步评估。
