Aricò Melodie O, Valletta Enrico, Caselli Désirée
U.O. Pediatria, Ospedale G.B. Morgagni-L. Pierantoni, AUSL Romagna, 47121 Forlì, Italy.
U.O.C. Malattie Infettive, Ospedale Pediatrico Giovanni XXIII, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70100 Bari, Italy.
Children (Basel). 2023 Apr 17;10(4):740. doi: 10.3390/children10040740.
Antibiotics account for over 10% of the overall drug expense of the National Health System in Italy in 2021. Their use in children is of particular interest on one side, because acute infections are very common in children, while they build their immunologic library of competence; on the other side, although many acute infections are expected and turn out to be of viral origin, caregivers will often ask the family doctor or primary care attending to reassure them by prescribing antibiotic treatment, although it may often be unnecessary. The inappropriate prescription of antibiotics in children may likely be a source not only of undue economic burden for the public health system but also of increasing development of antimicrobial resistance (AMR). Based on those issues, the inappropriate use of antibiotics in children should be avoided to reduce the risks of unnecessary toxicity, increase in health costs, lifelong effects, and selection of resistant organisms causing undue deaths. Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure an optimal use of antimicrobials to improve patient outcomes while limiting the risk of adverse events including AMR. The aim of this paper is to spread some concept of good use of antibiotics for pediatricians or every other physician involved in the choice to prescribe, or not, antibiotics in children. Several actions could be of help in this process, including the following: (1) identify patients with high probability of bacterial infection; (2) collect samples for culture study before starting antibiotic treatment if invasive bacterial infection is suspected; (3) select the appropriate antibiotic molecule based on local resistance and narrow spectrum for the suspected pathogen(s); avoid multi-antibiotic association; prescribe correct dosage; (4) choose the best route of administration (oral vs. parenteral) and the best schedule of administration for every prescription (i.e., multiple administration for beta lactam); (5) schedule clinical and laboratory re-evaluation with the aim to consider therapeutic de-escalation; (6) stop antibiotic administration as soon as possible, avoiding the application of "antibiotic course".
2021年，抗生素在意大利国家卫生系统的药品总费用中占比超过10%。一方面，抗生素在儿童中的使用尤为令人关注，因为急性感染在儿童中非常常见，而他们正处于构建免疫能力库的阶段；另一方面，尽管许多急性感染预期是病毒感染且最终也证实为病毒感染，但看护者通常会要求家庭医生或初级护理医生通过开具抗生素治疗来让他们安心，尽管这往往是不必要的。儿童抗生素的不恰当处方不仅可能给公共卫生系统带来不必要的经济负担，还可能导致抗菌药物耐药性（AMR）的不断增加。基于这些问题，应避免儿童抗生素的不当使用，以降低不必要的毒性风险、增加医疗成本、终身影响以及选择导致不当死亡的耐药菌的风险。抗菌药物管理（AMS）描述了一系列连贯的行动，以确保抗菌药物的最佳使用，改善患者预后，同时限制包括AMR在内的不良事件风险。本文旨在向儿科医生或其他参与决定是否给儿童开具抗生素的医生传播一些合理使用抗生素的概念。在此过程中，有几项行动可能会有所帮助，包括以下几点：（1）识别细菌感染可能性高的患者；（2）如果怀疑有侵袭性细菌感染，在开始抗生素治疗前采集样本进行培养研究；（3）根据当地耐药情况和针对疑似病原体的窄谱选择合适的抗生素分子；避免联合使用多种抗生素；开具正确剂量；（4）为每次处方选择最佳给药途径（口服与胃肠外给药）和最佳给药方案（即β-内酰胺类药物多次给药）；（5）安排临床和实验室重新评估，以考虑治疗降级；（6）尽快停止抗生素给药，避免使用“抗生素疗程”。
