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1. Point Prevalence Surveys of Antibiotic Prescribing in Children at a Tertiary Hospital in a resource constraint, low- income sub-Saharan African country

Author

PATRICIA AKINTAN, Philip Oshun, Chioma Osuagwu, Olafoyekemi Ola-Bello, Iretiola Fajolu, Alero Roberts, Edamisan Temiye, and Oduyebo Oyinlola

Abstract

Background Antibiotic resistance has been widely described in children by various pathogens to multiple antibiotics, these have become a global health crisis and an emergency. Factors associated with antibiotic use are both community and hospital based as studies have reported increased use of antibiotics by parents and caregivers as well as health care providers This study aimed to describe prevalence rates of antibiotic prescribing and evaluate antibiotic prescribing practices as well as targets for improving the quality of antimicrobial prescribing in children over time. Method Point prevalence survey of antimicrobial use was performed yearly for 4 years to monitor trends in antimicrobial prescribing., Data from all patients admitted before 8 am on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data-entry, validation and analysis (http://www.global-pps.com). Results A total of 260 children including 90 (34.6%) neonates and 170 (65.4%) older children were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9–89.5% but reduced from 100–58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7–24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indication for antibiotic prescribing was sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33–100% while stop review date also increased from 19.4–82.1%. Conclusion The prevalence of antibiotic use was high with cephalosporins being the most prescribed antibiotic.

Published
2022
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2. Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): results from a worldwide point prevalence survey in 69 countries

Author

Pauwels, Ines, Versporten, Ann, Drapier, Nico, Vlieghe, Erika, Goossens, Herman, Koraqi, Andi, Hoxha, Iris, Tafaj, Silva, Cornistein, Wanda, Quiros, Rodolfo, Hojman, Martin, Ghazaryan, Lilit, Horne, Kylie, Cairns, Kelly, Doukas, Fiona, Gottlieb, Thomas, Sermijn, Erica, Verhamme, Katia, Brands, Christiane, Van Herendael, Bruno, Filippin, Lorenzo, Vandewal, Wouter, Konopnicki, Deborah, Maillart, Evelyne, Teixeira Lopes, Liliana, Papin, Pauline, Smits, Ilse, Jansens, Hilde, Bartholomeus, Sofie, Van den Abeele, Anne-Marie, Steyaert, Sophia, Piette, Anne, Buyle, Franky, Cartuyvels, Reinoud, Jonckheere, Stijn, Wybo, Ingrid, Vanneste, Lorenz, Mathieu, Delphine, Firre, Eric, Westelinck, Veerle, Gadisseux, Philippe, Dugernier, Thierry, Bafort, Kristof, Gonissen, Viviane, Vanderper, Vanessa, Gabriels, Patrick, Weekers, Frank, Michel, Philippe, Van Liedekerke, Ann, Costers, Michiel, Catry, Boudewijn, Dedeic-Ljubovic, Amela, Gales, Ana C., Matos Porto, Ana Paula, Figueiredo Costa, Silvia, Keuleyan, Emma, Beidi, Apollinaire, Cissohko, Youssouph, Blakwe, Habsatou, Batchaya Basile, Ngassa, German, Greg J., Lutes, Sarah, Boswell, Jennifer, Mertz, Dominik, Nguyen, Tuyen, MacLaggan, Timothy, Landry, Daniel, Ang, Anita, Thirion, Daniel J.G., Frenette, Charles, Émond, Yannick, Roberts, Jacqueline, Chang, Sandra, Kosar, Justin, Valiquette, Louis, Dutrisac, Ginette, Afra, Kevin, McGeer, Allison, Carrier, Marie, Grant, Jennifer, Labarca, Jaime, Carvajal, Camila, Lin, HongYi, Wang, Qiang, Yang, Jing, Yang, Wenjie, Cortes, Jorge A., Villalobos-Vindas, Juan, Ramírez-Valverde, Carlos, Horvatic, Jasminka, Pristas, Irina, Paphitou, Niki, Rummukainen, Maija-Liisa, Froissart, Antoine, Vanhems, Philippe, Pagava, Karaman, Korinteli, Irma, Brandt, Tobias, Gaertner, Johannes, Enimil, Anthony, Roilides, Emmanuel, Hajdú, Edit, Sengupta, Sharmila, Singh, Sanjeev, Patil, Priyanka, Poojary, Aruna, Soltani, Jafar, Pouladfar, Gholamreza, Jafarpour, Zahra, Alinia, Cyrus, Ameen, Hadi, Fitzgerald, David, Paul, Mical, Maor, Yasmin, Strahilevitz, Jacob, Chowers, Michal, Temkin, Elizabeth, Luca, Arnoldo, Ishibashi, Noriomi, Gu, Yoshiaki, Darwish Elhajji, Feras, Karabukayeva, Aizhan, Raka, Denis, Kambaralieva, Baktygul, Zarakauska, Lelde, Zarb, Peter, Hernandez Chena, Blanca Estela, Gonzalez-Diaz, Esteban, Corona-Meléndez, JuanCarlos, Torres Erazo, Darwin Stalin, Loza-Jalil, Suria Elizabeth, Molina, Julio, Candelas, Jose Antonio, Mijovic, Gordana, Duborija-Kovacevic, Natasa, Jong, Eefje, Kluytmans, Jan, van Elzakker, Erika, Schweitzer, Valentijn, Davies, Nicola, Iregbu, Kenneth, Nwajiobi-Princewill, Philip, Nwafia, Ifeyinwa, Fasuyi, Temitayo, Aboderin, Aaron, Elikwu, Charles John, Fadeyi, Abayomi, Ola-Bello, Olafoyekemi, Oduyebo, Oyinlola, Adedosu, Akin Nelson, Ekuma, Agantem, Shaqiri, Erjona, Saleem, Zikria, De Los Reyes, Mari Rose, Tavares, Luis, Kim, Nam Joong, Rachina, Svetlana, Alharthi, Alwaleed R., Enani, Mushira, Faried, Osama, Mirghani, Mohamed, Carevic, Biljana, Radulovic, Lili, Dragovac, Gorana, Tan, Sock Hoon, Taljaard, Jantjie, Chibabhai, Vindana, Joiner, Jennifer, Caston, Juan Jose, Núñez-Núñez, María, Martínez-Marcos, Francisco Javier, Ojeda-Burgos, Guillermo, Menendez, Maria Dolores, Retamar, Pilar, Corzo, Juan E., Rattanaumpawan, Pinyo, Salou, Mounerou, Mnif, Basma, Oncul, Ahsen, Babigumira, Peter Ahabwe, Olweny, James, Marshall, Emily, McCorry, Ann, Aldeyab, Mamoon, Khanna, Priya, Gormley, Cairine, Maloney, Sara, Cooper, Mandelin, Blackburn, Laura, Gessner-Wharton, Mallory, Vu, Lam, Greer, Nickie, Gawrys, Gerard, Kronmann, Lisha, Rios, Edgar, Hudson, Melissa, Lindholm, David A., The Global-PPS network, Vriendenkring VUB, Clinical sciences, Microbiology and Infection Control, and Clinical Biology

Subjects
Adult, Microbiology (medical), Point prevalence survey, Latin Americans, education, Population, MEDLINE, World Health Organization, Essential medicines, Antibiotic prescribing, Anti-Infective Agents, Environmental health, Prevalence, Humans, AcademicSubjects/MED00740, Medicine, Pharmacology (medical), Medical prescription, Biology, Original Research, Pharmacology, education.field_of_study, Adult patients, business.industry, Pharmacology. Therapy, Hospitals, Anti-Bacterial Agents, Anti-Bacterial Agents/therapeutic use, AcademicSubjects/MED00290, Infectious Diseases, Human medicine, AcademicSubjects/MED00230, business
Abstract

ObjectivesThe WHO Access, Watch and Reserve (AWaRe) classification has been developed to support countries and hospitals in promoting rational use of antibiotics while improving access to these essential medicines. We aimed to describe patterns of worldwide antibiotic use according to the AWaRe classification in the adult inpatient population.MethodsThe Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS) collects hospital antibiotic use data using a standardized PPS methodology. Global-PPS 2015, 2017 and 2018 data, collected by 664 hospitals in 69 countries, were categorized into AWaRe groups to calculate proportional AWaRe use, Access-to-Watch ratios and the most common indications for treatment with selected Watch antibiotics. Only prescriptions for systemic antibiotics on adult inpatient wards were analysed.ResultsRegional Access use ranged from 28.4% in West and Central Asia to 57.7% in Oceania, whereas Watch use was lowest in Oceania (41.3%) and highest in West and Central Asia (66.1%). Reserve use ranged from 0.03% in sub-Saharan Africa to 4.7% in Latin America. There were large differences in AWaRe prescribing at country level. Watch antibiotics were prescribed for a range of very different indications worldwide, both for therapeutic and prophylactic use.ConclusionsWe observed considerable variations in AWaRe prescribing and high use of Watch antibiotics, particularly in lower- and upper-middle-income countries, followed by high-income countries. The WHO AWaRe classification has an instrumental role to play in local and national stewardship activities to assess prescribing patterns and to inform and evaluate stewardship activities.

Published
2021
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4. Essential and Forgotten antibiotics: an inventory in low- and middle-income countries

Author

Tebano, Gianpiero, Li, Grace, Beovic, Bojana, Bielicki, Julia, Brink, Adrian, Enani, Mushira A, Godman, Brian, Hinrichsen, Sylvia Lemos, Kibuule, Dan, Gabriel, Levy-Hara, Oduyebo, Oyinlola, Sharland, Mike, Singh, Sanjeev, Wertheim, Heiman FL, Nathwani, Dilip, Pulcini, Celine, In, European Soc Clinical Microbiol, Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Paediatric Infectious Diseases Research Group [London, UK], St George's, University of London-Institute for Infection and Immunity [London, UK], University of Ljubljana, University of Cape Town, King Fahad Medical City, Karolinska Institutet [Stockholm], Universidade Federal de Pernambuco [Recife] (UFPE), University of Namibia, Hospital Carlos G. Durand, University of Lagos, Amrita Institute of Medical Sciences and Research Center, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Oxford University Clinical Research Unit [Ho Chi Minh City] (OUCRU), University of Dundee, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CCSD, Accord Elsevier, Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière], King Fahad Medical City [Riyadh] (KFMC), and University of Namibia (UNAM)

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, medicine.drug_class, 030106 microbiology, Antibiotics, Global Health, World Health Organization, Communicable Diseases, Essential medicines, RS, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, 0302 clinical medicine, Ampicillin, Prevalence, Global health, medicine, Humans, Antimicrobial stewardship, Pharmacology (medical), 030212 general & internal medicine, Survey, Developing Countries, Antibiotic stewardship, Low- and middle-income countries, business.industry, General Medicine, Amoxicillin, Access, Anti-Bacterial Agents, 3. Good health, Penicillin, Metronidazole, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], Infectious Diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, medicine.drug, Antibiotic access
Abstract

Background The World Health Organization Essential Medicines List (WHO-EML) includes ‘access’ antibiotics, judged essential to treat common infections. The European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship defined a list of ‘forgotten’ antibiotics, some old and often off-patent antibiotics, which have particular value for specific indications. Objective To investigate which WHO-EML ‘access’ and ‘forgotten’ antibiotics are approved at national level in a sample of low- to middle-income countries (LMICs). Methods The Scientific Committee used a consensus procedure to select 26 WHO-EML ‘access’ and 15 ‘forgotten’ antibiotics. Paediatric formulations were explored for 14 antibiotics. An internet-based questionnaire was circulated to 40 LMIC representatives. Antibiotics were defined as approved if an official drug regulatory agency and/or the national ministry of health licensed their use, making them, at least theoretically, available on the market. Results Twenty-eight LMICs (11 in Africa, 11 in Asia and six in America) were surveyed. Nine WHO-EML ‘access’ antibiotics (amoxicillin, ampicillin, benzylpenicillin, ceftriaxone, clarithromycin, ciprofloxacin, doxycycline, gentamicin and metronidazole) were approved in all countries, and all 26 ‘access’ antibiotics were approved in more than two-thirds of countries. Among the 15 ‘forgotten’ antibiotics, only one was approved in more than two-thirds of countries. The median number of approved antibiotics per country was 30 (interquartile range 23–35). Six of 14 paediatric formulations (amoxicillin, amoxicillin-clavulanic acid, oral antistaphylococcal penicillin, cotrimoxazole, erythromycin and metronidazole) were approved in more than two-thirds of countries. Conclusions WHO-EML ‘access’ antibiotics and the most frequently used formulations for paediatrics were approved in the vast majority of the 28 surveyed LMICs. This was not the case for many of the ‘forgotten’ antibiotics, despite their important role, particularly in areas with high prevalence of multi-drug-resistant bacteria.

Published
2019
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5. Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

Author

Hsia, Yingfen, Lee, Brian R, Versporten, Ann, Yang, Yonghong, Bielicki, Julia, Jackson, Charlotte, Newland, Jason, Goossens, Herman, Magrini, Nicola, Sharland, Mike, Irwin, Adam, Akula, Akhila, Bamford, Alasdair, Chang, Amanda, da Silva, Andre, Whitelaw, Andrew, Dramowski, Angela, Vasudevan, Anil Kumar, Sharma, Anita, Justicia, Antonio, Chikkappa, Ashok, Slowinska-Jarzabek, Barbara, Rippberger, Bianca, Zhao, Changan, Tersigni, Chiara, Cheng, Chinglan, Harkensee, Christian, Jing, Chuamei, Zhu, Chunmei, Li, Chunyan, Tagliabue, Claudia, Epalza, Cristina, Jacqueline, Daglish, Tian, Daiyin, Jinka, Dasaratha, Gkentzi, Despoina, Dharmapalan, Dhanya, Benadof, Dona, Papadimitriou, Eleni, Iosifidis, Elias, Roilides, Emmanuel, Yarci, Erbu, Majda-Stanisławska, Ewa, Gowin, Ewelina, Chappell, Faye, Torres, Federico Martinon, Collett-White, Francis, Liu, Gang, Lu, Gen, Syrogiannopoulos, George, Pitsava, Georgia, Alvarez-Uria, Gerardo, Renk, Hana, Mahmood, Hana, Saxen, Harri, Finlayson, Heather, Green, Helen, Rabie, Helena, Kandraju, Hemasree, Zhang, Hong, Okokon, Ita, Cross, Jack, Herberg, Jethro, Li, Jianping, Zhang, Jiaosheng, Deng, Jikui, Liu, Jing, Qian, Jing, Yang, Jinhong, Sicińska, Joanna, Hübner, Johannes, Fukuoka, Kahoru, Yao, Kaihu, Cheung, Kaman, Ojeda, Karla, Kaffe, Katerina, Kreitmeyer, Katharina, Doerholt, Katja, Grimwood, Keith, Ledoare, Kirsty, Vazouras, Konstantinos, Shen, Kunling, Tang, Lanfang, Zhang, Lehai, Lin, Li, Ashkenazi-Hoffnung, Liat, Wu, Lijuan, Wang, Lijun, Teston, Lilian, Galli, Luisa, Speirs, Lynne, Tsolia, Maria, Hufnagel, Markus, Knuf, Markus, Duse, Marzia, Ding, Mingjie, Rozic, Mojca, Premru, Mueller, O'Connell, Natasha, Rieber, Nikolaus, Spyridis, Nikos, Tunga, Onkaraiah, Conejo, Pablo Rojo, McMaster, Paddy, Lumbiganon, Pagakrong, Pansa, Paola, D'Argenio, Patrizia, Moriarty, Paul, Nikolic, Petra, Wang, Ping, Paopongsawan, Pongsatorn, Cao, Qing, Deng, Qiulian, Laxminarayan, Ramanan, Kanithi, Ravishankar, Jimenez, Rodolfo, Cao, Sancheng, Singh, Sanjeev, Rees, Sarah, Praveen, Saroey, Kekomaki, Satu, Hackett, Scott, Ashkenazi, Shai, Chang, Si Min, Drysdale, Simon, Koning, Sonia, Subramanian, Sreeram, Murki, Srinivas, Vergnano, Stefania, Gandra, Sumanth, Esposito, Susanna, Anugulruengkitt, Suvaporn, Puthanakit, Thanyawee, Behrends, Uta, Papaevangelous, Vana, Jian, Victoria, Li, Wei, Zhao, Wei, Wang, Wei, Zhang, Wenshuang, Mu, Xiaoping, Dong, Xiaoyie, Jiang, Xiyuan, Chen, Xu, Wang, Yi, Zheng, Yuejie, Horikoshi, Yuho, Aboderin, Aaron, Olayinka, Adebola, Dedeic-Ljubovic, Amela, McCorry, Ann, Enimil, Anthony, Neubert, Antje, solano, antonio, Pignatari, Antonio, Poojary, Aruna, Kambaralieva, Baktygul, McCullagh, Bernadette, Carevi, Biljana, Van Herendael, Bruno, Gormley, Cairine, Carvajal, Camila, Ramírez, Carlos, Fitzgerald, David, Sabuda, Deana, Konopnicki, Deborah, Lacej, Denada, Pierard, Denis, Rios, Edgar, Marshall, Emily, Firre, Eric, van Elzakker, Erika, Shaqiri, Erjona, Darwish Elhajji, Feras, Gawrys, Gerard, Markovic, Goran, Kunsihima, Hiroyuki, Chen, Hui Hiong, Sviestina, Inese, Pristas, Irina, Hoxha, Iris, Korinteli, Irma, Mareković, Ivana, Soltani, Jafar, Labarca, Jaime, AlSalman, Jameela, Horvatic, Jasminka, Frimpong, Juliet Ampomah, Pagava, Karaman, Kei, Kasahara, Okinaka, Keiji, Iregbu, Kenneth, Ghazaryan, Lilit, Raka, Lul, Gessner-Wharton, Mallory, Aldeyab, Mamoon, Cooper, Mandelin, del Castillo, Marcelo, Hojman, Martin, Hudson, Melissa, Alshehri, Mohamed, Ling, Moi Lin, Greer, Nickie, Oduyebo, Oyinlola, Buijtels, Patricia, TEROL BARRERO, PEDRO, Zarb, Peter, Schelstraete, Petra, Nwajiobi-Princewill, Princewill Ifeanyi Philip, Khanna, Priya, Quiros, Rodolfo, Simovic, Sanja, Thompson, Sarah, Chan, Si Min, Burokiene, Sigita, Rachina, Svetlana, Usonis, Vytautas, Cornistein, Wanda, Holemans, Xavier, Gu, Yoshiaki, Brothers, Adam, Hersh, Adam, Fernandez, Alfred, Tribble, Alison, Hurst, Amanda, Green, Andrea, Hammer, Benjamin, Lee, Betty P, Kuzmic, Brenik, Shapiro, Craig, Boge, Craig, Haslam, David, Berman, David, Naeem, Fouzia, Johnson, George, Schwenk, Hayden, Orr, Hillary, Maples, Holly, Olsen, Jared, Gerber, Jeffrey, Girotto, Jennifer, Zweiner, Jennifer, Goldman, Jennifer, Gillon, Jessica, Tansmore, Jessica, Manaloor, John, Courter, Joshua, Mongkolrattanothai, Kanokporn, Patel, Karisma, Merkel, Kathryn, Namtu, Katie, Flett, Kelly, Lee, Kelly, Nichols, Kristen, Klein, Kristin, Handy, Lori, Castagnini, Luis, Mazade, Marc, Heger, Margaret, Fernandez, Marisol, Chang, Michael, Crawford, Michelle, Nelson, Miranda, Bennett, Nicholas, Jaggi, Preeti, Hamdy, Rana, Banerjee, Ritu, Olivero, Rosemary, Patel, Sameer, Arnold, Sandra, Ogrin, Sara, Jones, Sarah, Parker, Sarah, Kubes, Sarah, Hymes, Saul, Weissman, Scott, Chan, Shannon, Henderson, Sheryl, Metjian, Talene, GARPEC and Global-PPS networks, on behalf of the, GARPEC Network, Global-PPS Network, Children's Hospital, HUS Children and Adolescents, and Clinicum

Subjects
medicine.medical_specialty, Adolescent, medicine.drug_class, 030231 tropical medicine, Antibiotics, MEDLINE, Psychological intervention, CHILDREN, World Health Organization, Pediatrics, Essential medicines, 03 medical and health sciences, Antimicrobial Stewardship, 0302 clinical medicine, Antibiotic resistance, POINT PREVALENCE SURVEY, SURVEILLANCE, Medicine and Health Sciences, Medicine, Antimicrobial stewardship, Humans, 030212 general & internal medicine, Medical prescription, Child, Neonatal sepsis, business.industry, lcsh:Public aspects of medicine, STEWARDSHIP, Infant, Newborn, Infant, lcsh:RA1-1270, General Medicine, medicine.disease, 3142 Public health care science, environmental and occupational health, Drug Utilization, 3. Good health, Anti-Bacterial Agents, QUALITY INDICATORS, Family medicine, Child, Preschool, Health Care Surveys, Human medicine, business, Pharmacy Service, Hospital
Abstract

Summary: Background: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. Methods: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. Findings: Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. Interpretation: There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. Funding: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS.

Published
2019

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