Empiric antibiotic prescribing guidelines in 84 European paediatric hospitals : wide variation in quality, drug choice and durationEmpiric antibiotic prescribing guidelines in 84 European paediatric hospitals : wide variation in quality, drug choice and duration
Faculty of Medicine and Health Sciences
Vaccine & Infectious Disease Institute (VAXINFECTIO)
Archives of disease in childhood. - London, 1926, currens
(2015), p. 1-16
University of Antwerp
Objective: To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their quality and content. Design: Cross-sectional survey as part of the ARPEC study. Participating hospitals completed an online questionnaire on the availability and quality of antibiotic prescribing guidelines and on empiric antibiotic treatment including recommended duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children. Results: 84 hospitals from 19 European countries participated in the survey of which74 confirmed the existence of guidelines. Complete guidelines were reported by only 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for UTI (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin are the antibiotics most commonly recommended for RTIs (up to 76%), cephalosporins for UTI (up to 50%) and for SSTI and bone infection (20% and 30% respectively). Antistaphylococcal penicillin recommendations for SSTIs and bone infections were 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%) and only a third of hospitals with guidelines for sepsis provide recommendations for length of therapy. Conclusion: Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in both the quality of guidelines and their evidence base of guidance is required, linking empiric therapy to resistance rates.