Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance (2025)

Abstract

Introduction: Surveillance of antibiotic use is crucial for identifying targets for antibiotic stewardship programs (ASPs), particularly in pediatric populations within countries like Pakistan, where antimicrobial resistance (AMR) is escalating. This pointprevalence survey (PPS) seeks to assess the patterns of antibiotic use in pediatricpatients across Punjab, Pakistan, employing the WHO AWaRe classification topinpoint targets for intervention and encourage rational antibiotic usage.

Methods: A PPS was conductedacross 23 pediatric wards of 14 hospitals in the Punjab Province of Pakistan using the standardized Global-PPS methodologydeveloped by the University of Antwerp. The study included all pediatricinpatients receiving antibiotics at the time of the survey, categorizing antibioticprescriptions according to the WHO Anatomical Therapeutic Chemicalclassification and the AWaRe classification system.

Results: Out of 498pediatric patients, 409 were receiving antibiotics,representing an antibiotic use prevalence of 82.1%. A substantial majority(72.1%) of the prescribed antibiotics fell under the WHO’s Watch category,with 25.7% in the Access category and 2.2% in the Reserve group. Thepredominant diagnoses were respiratory infections, notably pneumonia(32.4%). The most commonly used antibiotics were ceftriaxone (37.2%) andVancomycin (13.5%). Only 2% of antibiotic uses were supported by culturesensitivity reports, highlighting a reliance on empirical therapy.

Conclusion: The high prevalence ofantibiotic use, particularly from the Watchcategory, and low adherence to culture-based prescriptions underscore thecritical need for robust antibiotic stewardship programs in Pakistan.Strengthening these programs could help mitigate AMR and optimizeantibiotic use, aligning with global health objectives.

Original languageEnglish
Number of pages19
JournalFrontiers in Pediatrics
DOIs
Publication statusAccepted/In press - 24 Dec 2024

Keywords

  • pediatric
  • antimicrobial resistance (AMR)
  • antimicrobial stewardship (AMS)
  • Pakistan
  • point prevalence survey

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Sheikh, S., Saleem, Z., Afzal, S., Qamar, M. U., Raza, A., Naqvi, S. Z. H., Al-Rawi, B. A. (Accepted/In press). Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance. Frontiers in Pediatrics. https://doi.org/10.3389/fped.2024.1469766

Sheikh, Samia ; Saleem, Zikria ; Afzal, Shairyar et al. / Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan : point prevalence surveys using AWaRe guidance. In: Frontiers in Pediatrics. 2024.

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title = "Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance",

abstract = "Introduction: Surveillance of antibiotic use is crucial for identifying targets for antibiotic stewardship programs (ASPs), particularly in pediatric populations within countries like Pakistan, where antimicrobial resistance (AMR) is escalating. This pointprevalence survey (PPS) seeks to assess the patterns of antibiotic use in pediatricpatients across Punjab, Pakistan, employing the WHO AWaRe classification topinpoint targets for intervention and encourage rational antibiotic usage.Methods: A PPS was conductedacross 23 pediatric wards of 14 hospitals in the Punjab Province of Pakistan using the standardized Global-PPS methodologydeveloped by the University of Antwerp. The study included all pediatricinpatients receiving antibiotics at the time of the survey, categorizing antibioticprescriptions according to the WHO Anatomical Therapeutic Chemicalclassification and the AWaRe classification system.Results: Out of 498pediatric patients, 409 were receiving antibiotics,representing an antibiotic use prevalence of 82.1%. A substantial majority(72.1%) of the prescribed antibiotics fell under the WHO{\textquoteright}s Watch category,with 25.7% in the Access category and 2.2% in the Reserve group. Thepredominant diagnoses were respiratory infections, notably pneumonia(32.4%). The most commonly used antibiotics were ceftriaxone (37.2%) andVancomycin (13.5%). Only 2% of antibiotic uses were supported by culturesensitivity reports, highlighting a reliance on empirical therapy.Conclusion: The high prevalence ofantibiotic use, particularly from the Watchcategory, and low adherence to culture-based prescriptions underscore thecritical need for robust antibiotic stewardship programs in Pakistan.Strengthening these programs could help mitigate AMR and optimizeantibiotic use, aligning with global health objectives.",

keywords = "pediatric, antimicrobial resistance (AMR), antimicrobial stewardship (AMS), Pakistan, point prevalence survey",

author = "Samia Sheikh and Zikria Saleem and Shairyar Afzal and Qamar, {Muhammad Usman} and Ali Raza and Naqvi, {Syed Zeeshan Haider} and Al-Rawi, {Basil A} and Brian Godman",

note = "This article is part of the Research Topic {"}Pediatric Infectious Diseases and Global Action Plan on AMR{"}",

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Sheikh, S, Saleem, Z, Afzal, S, Qamar, MU, Raza, A, Naqvi, SZH, Al-Rawi, BA 2024, 'Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance', Frontiers in Pediatrics. https://doi.org/10.3389/fped.2024.1469766

Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance. / Sheikh, Samia ; Saleem, Zikria ; Afzal, Shairyar et al.
In: Frontiers in Pediatrics, 24.12.2024.

Research output: Contribution to journalArticlepeer-review

TY - JOUR

T1 - Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan

T2 - point prevalence surveys using AWaRe guidance

AU - Sheikh, Samia

AU - Saleem, Zikria

AU - Afzal, Shairyar

AU - Qamar, Muhammad Usman

AU - Raza, Ali

AU - Naqvi, Syed Zeeshan Haider

AU - Al-Rawi, Basil A

AU - Godman, Brian

N1 - This article is part of the Research Topic "Pediatric Infectious Diseases and Global Action Plan on AMR"

PY - 2024/12/24

Y1 - 2024/12/24

N2 - Introduction: Surveillance of antibiotic use is crucial for identifying targets for antibiotic stewardship programs (ASPs), particularly in pediatric populations within countries like Pakistan, where antimicrobial resistance (AMR) is escalating. This pointprevalence survey (PPS) seeks to assess the patterns of antibiotic use in pediatricpatients across Punjab, Pakistan, employing the WHO AWaRe classification topinpoint targets for intervention and encourage rational antibiotic usage.Methods: A PPS was conductedacross 23 pediatric wards of 14 hospitals in the Punjab Province of Pakistan using the standardized Global-PPS methodologydeveloped by the University of Antwerp. The study included all pediatricinpatients receiving antibiotics at the time of the survey, categorizing antibioticprescriptions according to the WHO Anatomical Therapeutic Chemicalclassification and the AWaRe classification system.Results: Out of 498pediatric patients, 409 were receiving antibiotics,representing an antibiotic use prevalence of 82.1%. A substantial majority(72.1%) of the prescribed antibiotics fell under the WHO’s Watch category,with 25.7% in the Access category and 2.2% in the Reserve group. Thepredominant diagnoses were respiratory infections, notably pneumonia(32.4%). The most commonly used antibiotics were ceftriaxone (37.2%) andVancomycin (13.5%). Only 2% of antibiotic uses were supported by culturesensitivity reports, highlighting a reliance on empirical therapy.Conclusion: The high prevalence ofantibiotic use, particularly from the Watchcategory, and low adherence to culture-based prescriptions underscore thecritical need for robust antibiotic stewardship programs in Pakistan.Strengthening these programs could help mitigate AMR and optimizeantibiotic use, aligning with global health objectives.

AB - Introduction: Surveillance of antibiotic use is crucial for identifying targets for antibiotic stewardship programs (ASPs), particularly in pediatric populations within countries like Pakistan, where antimicrobial resistance (AMR) is escalating. This pointprevalence survey (PPS) seeks to assess the patterns of antibiotic use in pediatricpatients across Punjab, Pakistan, employing the WHO AWaRe classification topinpoint targets for intervention and encourage rational antibiotic usage.Methods: A PPS was conductedacross 23 pediatric wards of 14 hospitals in the Punjab Province of Pakistan using the standardized Global-PPS methodologydeveloped by the University of Antwerp. The study included all pediatricinpatients receiving antibiotics at the time of the survey, categorizing antibioticprescriptions according to the WHO Anatomical Therapeutic Chemicalclassification and the AWaRe classification system.Results: Out of 498pediatric patients, 409 were receiving antibiotics,representing an antibiotic use prevalence of 82.1%. A substantial majority(72.1%) of the prescribed antibiotics fell under the WHO’s Watch category,with 25.7% in the Access category and 2.2% in the Reserve group. Thepredominant diagnoses were respiratory infections, notably pneumonia(32.4%). The most commonly used antibiotics were ceftriaxone (37.2%) andVancomycin (13.5%). Only 2% of antibiotic uses were supported by culturesensitivity reports, highlighting a reliance on empirical therapy.Conclusion: The high prevalence ofantibiotic use, particularly from the Watchcategory, and low adherence to culture-based prescriptions underscore thecritical need for robust antibiotic stewardship programs in Pakistan.Strengthening these programs could help mitigate AMR and optimizeantibiotic use, aligning with global health objectives.

KW - pediatric

KW - antimicrobial resistance (AMR)

KW - antimicrobial stewardship (AMS)

KW - Pakistan

KW - point prevalence survey

UR - https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2024.1469766/abstract

U2 - 10.3389/fped.2024.1469766

DO - 10.3389/fped.2024.1469766

M3 - Article

JO - Frontiers in Pediatrics

JF - Frontiers in Pediatrics

ER -

Sheikh S, Saleem Z, Afzal S, Qamar MU, Raza A, Naqvi SZH et al. Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance. Frontiers in Pediatrics. 2024 Dec 24. doi: 10.3389/fped.2024.1469766

Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance (2025)

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