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1. Antibiotic prescribing and expenditures in outpatient paediatrics in Greece, 2010-13.

Author

Kourlaba G, Kourkouni E, Spyridis N, Gerber JS, Kopsidas J, Mougkou K, Lourida A, and Zaoutis TE

Subjects
Adolescent, Child, Child, Preschool, Female, Greece, Humans, Infant, Infant, Newborn, Male, Young Adult, Ambulatory Care methods, Anti-Bacterial Agents economics, Anti-Bacterial Agents therapeutic use, Drug Prescriptions, Drug Utilization, Health Expenditures
Abstract

Objectives: The objectives of this study were to provide a nationally representative analysis of antibiotic prescribing in outpatient paediatrics and to assess overall and class-specific antibiotic costs in Greece., Methods: Data on antibiotic prescriptions for patients aged ≤19 years old between July 2010 and June 2013 in Greece were extracted from the IMS Health Xponent database. Antibiotics were grouped into narrow- and broad-spectrum agents. The number of prescribed antibiotics and census denominators were used to calculate prescribing rates. The total costs associated with prescribed antibiotics were calculated., Results: More than 7 million antibiotics were prescribed during the study period, with an annual rate of 1100 antibiotics/1000 persons. Prescribing rates were higher among children aged <10 years old. Acute respiratory tract infections (ARTIs) accounted for 80% of prescribed antibiotics, with acute otitis media (22.3%), acute tonsillitis (19.5%) and acute bronchitis/bronchiolitis (13.9%) being the most common clinical diagnoses. Cephalosporins (32.9%), penicillins (32.3%) and macrolides (32.1%) were the most commonly prescribed antibiotic classes. The majority (90.4%) of antibiotics were broad spectrum. Antibiotic expenditures totalled ∼€50 million., Conclusions: Broad-spectrum antibiotic prescribing is common in outpatient paediatric patients. These data provide important targets to inform the development of an outpatient antimicrobial stewardship programme targeting specific practices, providers and conditions., (© The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Published
2015
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2. Comparing neonatal and paediatric antibiotic prescribing between hospitals: a new algorithm to help international benchmarking.

Author

Porta A, Hsia Y, Doerholt K, Spyridis N, Bielicki J, Menson E, Tsolia M, Esposito S, Wong IC, and Sharland M

Subjects
Algorithms, Benchmarking methods, Child, Child, Preschool, Europe, Female, Hospitals, Pediatric, Humans, Infant, Male, Models, Statistical, Pilot Projects, Anti-Bacterial Agents administration & dosage, Drug Prescriptions statistics & numerical data, Drug Utilization statistics & numerical data
Abstract

Objectives: The WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) methodology is a standardized method of comparing antimicrobial use. The ATC/DDD is defined as the average maintenance daily dose of a drug used in a 70 kg adult, ignoring the considerable differences in body weight of neonates and children. The aim of this study was to develop a new standardized way of comparing rates of antimicrobial prescribing between European children's hospitals., Methods: This pilot study at four European children's hospitals (in the UK, Greece and Italy) collected data including demographics, antibiotic use, dosing and indication in children and neonates over a 14 day period., Results: A total of 1217 antibiotic prescriptions were issued with 47 different antibiotics used. Approximately half of all children and a third of all neonates received antibiotics, with wide variation between centres in the type and dose of antibiotic used. We propose a new pragmatic three-step algorithm. The first step includes a simple comparison of the proportion of hospitalized children on antibiotics by weight bands and the number of antimicrobials that account for 90% of total DDD drug usage (DU90%). The second step is a comparison of the dosing used (mg/kg/day). The third step is to compare overall drug exposure using DDD/100 bed days for standardized weight bands between centres., Conclusions: This novel method has the potential to be a useful tool to provide antibiotic use comparator data and requires validation in a large prospective point prevalence study.

Published
2012
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3. Dosing of oral penicillins in children: is big child=half an adult, small child=half a big child, baby=half a small child still the best we can do?

Author

Ahmed U, Spyridis N, Wong IC, Sharland M, and Long PF

Subjects
Administration, Oral, Adult, Age Factors, Child, Child, Preschool, Dose-Response Relationship, Drug, Humans, Infant, Pediatrics, Practice Patterns, Physicians', Anti-Bacterial Agents administration & dosage, Body Weight, Drug Prescriptions statistics & numerical data, Gram-Positive Bacterial Infections drug therapy, Penicillin V administration & dosage
Published
2011
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4. The worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children

Author

Versporten A1, Bielicki J2, Drapier N1, Sharland M2, Goossens H3, ARPEC project group. Calle GM, Garrahan JP, Clark J, Cooper C, Blyth CC, Francis JR, Alsalman J, Jansens H, Mahieu L, Van Rossom P, Vandewal W, Lepage P, Blumental S, Briquet C, Robbrecht D, Maton P, Gabriels P, Rubic Z, Kovacevic T, Nielsen JP, Petersen JR, Poorisrisak P, Jensen LH, Laan M, Tamm E, Matsinen M, Rummukainen ML, Gajdos V, Olivier R, Le Maréchal F, Martinot A, Dubos F, Lagrée M, Prot-Labarthe S, Lorrot M, Orbach D, Pagava K, Hufnagel M, Knuf M, Schlag SA, Liese J, Renner L, Enimil A, Awunyo M, Syridou G, Spyridis N, Critselis E, Kouni S, Mougkou K, Ladomenou F, Gkentzi D, Iosifidis E, Roilides E, Sahu S, Murki S, Malviya M, Kalavalapalli DB, Singh S, Singhal T, Garg G, Garg P, Kler N, Soltani J, Jafarpour Z, Pouladfar G, Nicolini G, Montagnani C, Galli L, Esposito S, Tenconi R, Lo Vecchio A, Dona' D, Giaquinto C, Borgia E, D'Argenio P, De Luca M, Centenari C, Raka L, Raka D, Omar A, Al-Mousa H, Mozgis D, Sviestina I, Burokiene S, Usonis V, Tavchioska G, Hargadon-Lowe A, Zarb P, Borg MA, González Lozano CA, Zárate Castañon P, Cancino ME, McCullagh B, McCorry A, Gormley C, Al Maskari Z, Al-Jardani A, Pluta M, Rodrigues F, Brett A, Esteves I, Marques L, Ali AlAjmi J, Claudia Cambrea S, Rashed AN, Mubarak Al Azmi AA, Chan SM, Isa MS, Najdenov P, Čižman M, Unuk S, Finlayson H, Dramowski A, Maté-Cano I, Soto B, Calvo C, Santiago B, Saavedra-Lozano J, Bustinza A, Escosa-García L, Ureta N, Lopez-Varela E, Rojo P, Tagarro A, Barrero PT, Rincon-Lopez EM, Abubakar I, Aston J, Heginbothom M, Satodia P, Garbash M, Johnson A, Sharpe D, Barton C, Menson E, Arenas-Lopez S, Luck S, Doerholt K, McMaster P, Caldwell NA, Lunn A, Drysdale SB, Howe R, Scorrer T, Gahleitner F, Gupta R, Nash C, Alexander J, Raman M, Bell E, Rajagopal V, Kohlhoff S, Cox E, Zaoutis T., Mahieu, Ludo, ARPEC Project Grp, ARPEC project group, Versporten, A1, Bielicki, J2, Drapier, N1, Sharland, M2, Goossens, H3, ARPEC project group., Calle GM, Garrahan, Jp, Clark, J, Cooper, C, Blyth, Cc, Francis, Jr, Alsalman, J, Jansens, H, Mahieu, L, Van Rossom, P, Vandewal, W, Lepage, P, Blumental, S, Briquet, C, Robbrecht, D, Maton, P, Gabriels, P, Rubic, Z, Kovacevic, T, Nielsen, Jp, Petersen, Jr, Poorisrisak, P, Jensen, Lh, Laan, M, Tamm, E, Matsinen, M, Rummukainen, Ml, Gajdos, V, Olivier, R, Le Maréchal, F, Martinot, A, Dubos, F, Lagrée, M, Prot-Labarthe, S, Lorrot, M, Orbach, D, Pagava, K, Hufnagel, M, Knuf, M, Schlag, Sa, Liese, J, Renner, L, Enimil, A, Awunyo, M, Syridou, G, Spyridis, N, Critselis, E, Kouni, S, Mougkou, K, Ladomenou, F, Gkentzi, D, Iosifidis, E, Roilides, E, Sahu, S, Murki, S, Malviya, M, Kalavalapalli, Db, Singh, S, Singhal, T, Garg, G, Garg, P, Kler, N, Soltani, J, Jafarpour, Z, Pouladfar, G, Nicolini, G, Montagnani, C, Galli, L, Esposito, S, Tenconi, R, Lo Vecchio, A, Dona', D, Giaquinto, C, Borgia, E, D'Argenio, P, De Luca, M, Centenari, C, Raka, L, Raka, D, Omar, A, Al-Mousa, H, Mozgis, D, Sviestina, I, Burokiene, S, Usonis, V, Tavchioska, G, Hargadon-Lowe, A, Zarb, P, Borg, Ma, González Lozano, Ca, Zárate Castañon, P, Cancino, Me, Mccullagh, B, Mccorry, A, Gormley, C, Al Maskari, Z, Al-Jardani, A, Pluta, M, Rodrigues, F, Brett, A, Esteves, I, Marques, L, Ali AlAjmi, J, Claudia Cambrea, S, Rashed, An, Mubarak Al Azmi, Aa, Chan, Sm, Isa, M, Najdenov, P, Čižman, M, Unuk, S, Finlayson, H, Dramowski, A, Maté-Cano, I, Soto, B, Calvo, C, Santiago, B, Saavedra-Lozano, J, Bustinza, A, Escosa-García, L, Ureta, N, Lopez-Varela, E, Rojo, P, Tagarro, A, Barrero, Pt, Rincon-Lopez, Em, Abubakar, I, Aston, J, Heginbothom, M, Satodia, P, Garbash, M, Johnson, A, Sharpe, D, Barton, C, Menson, E, Arenas-Lopez, S, Luck, S, Doerholt, K, Mcmaster, P, Caldwell, Na, Lunn, A, Drysdale, Sb, Howe, R, Scorrer, T, Gahleitner, F, Gupta, R, Nash, C, Alexander, J, Raman, M, Bell, E, Rajagopal, V, Kohlhoff, S, Cox, E, and Zaoutis, T.

Subjects
0301 basic medicine, Male, Pediatrics, Latin Americans, Cross-sectional study, Prevalence, Psychological intervention, Drug resistance, Global Health, infectious diseases, 0302 clinical medicine, Global health, Medicine, 030212 general & internal medicine, Child, antibiotics, children, Drugs -- Prescribing, Pharmacology. Therapy, Hospitals -- Europe, Drug Resistance, Microbial, Hospitals, Anti-Bacterial Agents, Europe, Child, Preschool, Anti-infective agents, Female, medicine.drug, Microbiology (medical), medicine.medical_specialty, Cefepime, 030106 microbiology, Drug Prescriptions, 03 medical and health sciences, Surgical prophylaxis, pharmacology, pharmacology (medical), Environmental health, Humans, Biology, Quality Indicators, Health Care, business.industry, Health status indicators -- Europe, Infant, Drug Utilization, Cross-Sectional Studies, Health Care Surveys, Human medicine, business
Abstract

Objectives: Previously, web-based tools for cross-sectional antimicrobial point prevalence surveys (PPSs) have been used in adults to develop indicators of quality improvement. We aimed to determine the feasibility of developing similar quality indicators of improved antimicrobial prescribing focusing specifically on hospitalized neonates and children worldwide. Methods: A standardized antimicrobial PPS method was employed. Included were all inpatient children and neonates receiving an antimicrobial at 8:00 am on the day of the PPS. Denominators included the total number of inpatients. A web-based application was used for data entry, validation and reporting. We analysed 2012 data from 226 hospitals (H) in 41 countries (C) from Europe (174H; 24C), Africa (6H; 4C), Asia (25H; 8C), Australia (6H), Latin America (11H; 3C) and North America (4H). Results: Of 17693 admissions, 6499 (36.7%) inpatients received at least one antimicrobial, but this varied considerably between wards and regions. Potential indicators included very high broad-spectrum antibiotic prescribing in children of mainly ceftriaxone (ranked first in Eastern Europe, 31.3%; Asia, 13.0%; Southern Europe, 9.8%), cefepime (ranked third in North America, 7.8%) and meropenem (ranked first in Latin America, 13.1%). The survey identified worryingly high use of critically important antibiotics for hospital-acquired infections in neonates (34.9%; range from 14.2% in Africa to 68.0% in Latin America) compared with children (28.3%; range from 14.5% in Africa to 48.9% in Latin America). Parenteral administration was very common among children in Asia (88%), Latin America (81%) and Europe (67%). Documentation of the reasons for antibiotic prescribing was lowest in Latin America (52%). Prolonged surgical prophylaxis rates ranged from 78% (Europe) to 84% (Latin America). Conclusions: Simple web-based PPS tools provide a feasible method to identify areas for improvement of antibiotic use, to set benchmarks and to monitor future interventions in hospitalized neonates and children. To our knowledge, this study has derived the first global quality indicators for antibiotic use in hospitalized neonates and children., peer-reviewed

Published
2018

5. Variation in paediatric hospital antibiotic guidelines in Europe

Author

Spyridis, N., Syridou, G., Goossens, H., Versporten, A., Kopsidas, J., Kourlaba, G., Bielicki, J., Drapier, N., Zaoutis, T., Tsolia, M., Sharland, M., Vergison, A., Leon, V., Delestrait, M., Huza, C., Lepage, P., Mahieu, L., Boy, T., Jansens, H., Van Der Linden, D., Briquet, C., Allegaert, K., Smits, A., Gabriels, P., Vuye, A., Lutsar, I., Tamm, E., Larionova, A., Laan, D., Orbach, M., Lorrot, M., Angoulvant, F., Prot-Labarthe, S., Dubos, F., Lagree, M., Hufnagel, M., Schuster, K., Henneke, P., Roilides, E., Iosifidis, E., Corovessi, V., Michos, A., Galanakis, E., Gkentzi, D., Giacquinto, C., Longo, G., Dona', D., Mion, T., D'Argenio, P., Degli, M. L. C., De Luca, M., Ciliento, G., Esposito, S., Danieli, E., Montinaro, V., Tenconi, R., Nicolini, G., Sviestina, C. I. M., Pavare, J., Rasnaca, K., Gardovska, D., Usonis, V., Grope, I., Gurksniene, V., Eidukaite, A., Biver, A., Brett, A., Esteves, I., Cambrea, S. C., Craiu, M., Tomescu, E., Cizman, M., Babnik, J., Kenda, R., Vidmar, I., Nunez-Cuadros, E., Rojo, P., Lopez-Varela, E., Ureta, N., Perez-Lopez, A., Mosqueda, R., Orta, L., Santos, M., Navarro, M., Santiago, B., Hernandez-Sampelaya, T., Saavedra, J., Pineiro, R., Torel, P., Cano, I. M., Baumann, P., Berger, C., Menson, E., Botgros, A., Doerholt, K., Drysdale, S., Makwana, N., Mccorry, A., Garbash, E. M., Chetcutiganado, C., Mcleod, M., Caldwell, N., Nash, C., Mccullagh, B., Sharpe, D., Tweddell, L., Liese, J. G., Aston, J., Gallagher, A., Satodia, P., Howard-Smith, N., Korinteli, I., Tavchioska, G., Jensen, L., Trethon, A., Unuk, S., Childs, N., Canlas, J., Mahieu, Ludo, and ARPEC Project Grp

Subjects
Pediatrics, practice guidelines as topic, Antibiotics, cross-sectional studies, respiratory tract infections, sepsis, 0302 clinical medicine, newborn, Medicine, 030212 general & internal medicine, Practice Patterns, Physicians', humans, European paediatric hospitals, antibiotic guidelines, childhood infection, anti-bacterial agents, bacterial infections, child, preschool, drug administration schedule, drug prescriptions, Europe, hospitals, pediatric, infant, practice patterns, physicians', urinary tract infections, pediatrics, perinatology and child health, Antistaphylococcal penicillins, Respiratory tract infections, Neonatal sepsis, Hospitals, Pediatric, Child, Preschool, medicine.drug, medicine.medical_specialty, medicine.drug_class, Sepsis, 03 medical and health sciences, 030225 pediatrics, Internal medicine, business.industry, Infant, Newborn, Guideline, Amoxicillin, medicine.disease, Penicillin, Pediatrics, Perinatology and Child Health, Human medicine, business
Abstract

ObjectiveTo assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics.DesignParticipating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children.Results84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy.ConclusionsComprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.

Published
2015
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6. The antibiotic resistance and prescribing in European Children project: a neonatal and pediatric antimicrobial web-based point prevalence survey in 73 hospitals worldwide

Author

Versporten, A, Sharland, M, Bielicki, J, Drapier, N, Vankerckhoven, V, Goossens, H, ARPEC Project Group Members, Cooper, C, Lee, Ly, Whitehouse, J, Bryant, Pa, Haeusler, G, Curtis, N, Starr, M, Vergison, A, Léon, V, Delestrait, M, Huza, C, Lepage, P, Mahieu, L, Boiy, T, Jansens, H, Van der Linden, D, Briquet, C, Allegaert, K, Smits, A, Lutsar, I, Tamm, E, Larionova, A, Orbach, D, Lorrot, M, Angoulvant, F, Doit, C, Prot-Labarthe, S, Dubos, F, Lagree, M, Biscardi, S, Decobert, F, Hau, I, Madhi, F, Durrmeyer, X, Bojang, K, Abubakr, I, Okomo, U, Awe, R, Anderson, S, Akwara, I, Ideh, Rc, Pagava, K, Hufnagel, M, Schuster, K, Henneke, P, Enimil, A, Osei-Akoto, A, Nguah, Sb, Ansong, D, Iosifidis, E, Roilides, E, Spyridis, N, Syridou, G, Soltani, J, Soleimani, N, Nahedi, S, Khosravi, F, Pouladfar, G, Jafarpour, Z, Giacquinto, C, Longo, G, Donà, D, Mion, T, D'Argenio, P, Ciofi Degli Atti ML, De Luca, M, Ciliento, G, Esposito, S, Danieli, E, Montinaro, V, Tenconi, R, Centenari, C, Nicolini, G, Mozgis, D, Sviestina, I, Pavare, J, Rasnaca, K, Gardovska, D, Grope, I, Usonis, V, Gurksniene, V, Eidukaite, A, Biver, A, Bennett, A, O'Hare, B, Kennedy, N, Brett, A, Rodrigues, F, Esteves, I, Cambrea, Sc, Craiu, M, Tomescu, E, Al Shehri MA, Al Shahrani, D, Cizman, M, Babnik, J, Kenda, R, Vidmar, I, Finlayson, H, Rabie, H, Cotton, M, Dramowski, A, Rodrigo, C, Mendez, M, Rojo, P, López-Varela, E, Ureta, N, Mosqueda, R, Pérez-López, A, Orta, L, Santos, M, Navarro, M, Santiago, B, Hernández-Sampelayo, T, Saavedra, J, Bustinza, A, Gil, J, Valls, A, Santesteban, E, Baumann, P, Berger, C, Gifford, A, Menson, E, Botgros, A, Arenas-Lopez, S, Wade, P, Doerholt, K, Drysdale, Sb, Mcelnay, Jc, Kearney, Mp, Scott, Mg, Magee, Fa, Aldeyab, M, Heginbothom, M, Newland, Jg, Hedican, Eb, Shah, H, Stach, L, and Yu, D

Subjects
Microbiology (medical), Pediatrics, medicine.medical_specialty, medicine.drug_class, Antibiotics, MEDLINE, Drug resistance, Drug Prescriptions, point prevalence survey, antibiotic use, Antibiotic resistance, Intensive care, Drug Resistance, Bacterial, Medicine, Humans, Child, Electronic Data Processing, Internet, business.industry, Health services research, Antimicrobial, antimicrobial use, Confidence interval, Drug Utilization, Hospitals, Anti-Bacterial Agents, Europe, Infectious Diseases, Pediatrics, Perinatology and Child Health, surveillance, hospitalized children, Health Services Research, business, Public Health Administration
Abstract

Background The neonatal and pediatric antimicrobial point prevalence survey (PPS) of the Antibiotic Resistance and Prescribing in European Children project (http://www.arpecproject.eu/) aims to standardize a method for surveillance of antimicrobial use in children and neonates admitted to the hospital within Europe. This article describes the audit criteria used and reports overall country-specific proportions of antimicrobial use. An analytical review presents methodologies on antimicrobial use. Methods A 1-day PPS on antimicrobial use in hospitalized children was organized in September 2011, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antimicrobial treatment on the day of survey. Mandatory data were age, gender, (birth) weight, underlying diagnosis, antimicrobial agent, dose and indication for treatment. Data were entered through a web-based system for data-entry and reporting, based on the WebPPS program developed for the European Surveillance of Antimicrobial Consumption project. Results There were 2760 and 1565 pediatric versus 1154 and 589 neonatal inpatients reported among 50 European (n = 14 countries) and 23 non-European hospitals (n = 9 countries), respectively. Overall, antibiotic pediatric and neonatal use was significantly higher in non-European (43.8%; 95% confidence interval [CI]: 41.3-46.3% and 39.4%; 95% CI: 35.5-43.4%) compared with that in European hospitals (35.4; 95% CI: 33.6-37.2% and 21.8%; 95% CI: 19.4-24.2%). Proportions of antibiotic use were highest in hematology/oncology wards (61.3%; 95% CI: 56.2-66.4%) and pediatric intensive care units (55.8%; 95% CI: 50.3-61.3%). Conclusions An Antibiotic Resistance and Prescribing in European Children standardized web-based method for a 1-day PPS was successfully developed and conducted in 73 hospitals worldwide. It offers a simple, feasible and sustainable way of data collection that can be used globally.

Published
2013

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