AAP experts are stressing the importance of antibiotic stewardship following a study that predicted 39 million deaths from antimicrobial-resistant infections globally in the next 25 years.
Appropriate antibiotic use and vaccination can help drive down rates of these infections, and AAP resources can guide pediatricians.
Antibiotics are “one of the most important medical breakthroughs of the last hundred years,” according to Edmund A. Milder, M.D., M.S.C.E., FAAP, a member of the AAP Committee on Infectious Diseases’ (COID’s) subcommittee on antimicrobial stewardship. But they also have side effects that impact the microbiome, and overuse drives resistance as bacteria find ways to survive.
“Every time we give somebody a course of antibiotics, we’re always causing some harm,” said Dr. Milder, medical director for the Antimicrobial Stewardship Program at Rady Children’s Hospital - San Diego. “It’s just we have to weigh that against the benefits that come with it, but it’s never free.”
A study from the Global Research on Antimicrobial Resistance Project published in The Lancet found more than 1 million people around the world die each year of antimicrobial-resistant (AMR) infections. Deaths from methicillin-resistant Staphylococcus aureus more than doubled from 1990 to 2021. The group predicts rising death rates will lead to more than 39 million people dying from AMR infections between now and 2050.
“Antimicrobial medicines are one of the cornerstones of modern healthcare, and increasing resistance to them is a major cause for concern,” author Mohsen Naghavi, M.D., M.P.H., Ph.D., said in a news release. “These findings highlight that AMR has been a significant global health threat for decades and that this threat is growing.”
There was some positive news for children under 5 years, with deaths dropping 50% over the three decades of the study. However, authors noted young children with sepsis are “increasingly difficult to treat.”
The Centers for Disease Control and Prevention (CDC) estimates there are more than 2.8 million antimicrobial-resistant infections and more than 35,000 related deaths in the U.S. each year. The CDC is promoting appropriate use of antibiotics during Antibiotic Awareness Week from Nov. 18-24. This year’s theme is Fighting Antimicrobial Resistance Takes All of Us.
A recent study from CDC researchers showed improved awareness in recent years may be paying off. Antibiotic prescribing rates dropped 13% from 2011-’19. For children, they fell 25%.
Dr. Milder and Angela L. Myers, M.D., M.P.H., FAAP, who co-leads COID’s subcommittee on antimicrobial stewardship, said pediatricians can take several steps to help prevent antibiotic-resistant infections.
“What can we do each day is to continue to try to be clear about our diagnoses and make sure we know the patient meets criteria for a bacterial infection that requires antibiotics,” Dr. Milder said. “Then once we do that, when we’re selecting our antibiotic, we make sure we’re using the most narrow spectrum antibiotic possible for the shortest duration needed.”
Dr. Myers, division director, infectious diseases, at Children’s Mercy Kansas City, said some infections like uncomplicated urinary tract infection can be treated in as little as three days. The AAP Red Book includes a systems-based treatment table that can guide pediatricians in determining which antibiotic is appropriate for a specific condition and how long treatment should last. It is available in desktop and mobile versions.
“It’s all distilled in one place so they can flip through it pretty quickly,” Dr. Myers said. “… It’s based on the data that has been published so they should feel good about it, but it doesn’t create an expectation they should just remember it off the top of their head.”
The AAP also has an Education in Quality Improvement for Pediatric Practice (EQIPP) course on antibiotic decision-making and HealthyChildren.org content to help parents understand proper antibiotic use (see resources).
Dr. Myers said parents who bring their sick child to the pediatrician don’t necessarily need to be given antibiotics to be satisfied with their visit.
“What they want is an answer, and they want to know what they can do for their child,” she said.
That may include over-the-counter pain relievers, antihistamines, more fluids, suction or a cool mist humidifier depending on the diagnosis.
Pediatricians also can prevent antibiotic resistance by encouraging vaccination. The World Health Organization (WHO) recently estimated daily doses of antibiotics could drop by 2.5 billion each year through the use of vaccines against 23 pathogens.
“Addressing antimicrobial resistance starts with preventing infections, and vaccines are among the most powerful tools for doing that,” WHO Director-General Tedros Adhanom Ghebreyesus, Ph.D., M.Sc., said in a news release. “Prevention is better than cure, and increasing access to existing vaccines and developing new ones for critical diseases, like tuberculosis, is critical to saving lives and turning the tide on AMR.”
Resources
- AAP Red Book systems-based treatment table
- AAP policy Antibiotic Stewardship in Pediatrics
- AAP technical report Use of Antibiotics in Animal Agriculture: Implications for Pediatrics
- EQIPP: Antibiotic Decision Making online course
- Information from the CDC on antimicrobial resistance
- Information from the CDC on antibiotic prescribing
- Pediatrics Antibiotic Stewardship Program toolkit
- Answers to parents’ common antibiotic questions from HealthyChildren.org
