October 2, 2022

Prescribing antibiotics to children in 2022

Teri Woo, PhD, ARNP, CPNP-PC, CNL, FAANP, professor and director of nursing at Saint Martin’s University in Lacey, Washington, began her discussion of antibiotic prescribing with compelling statistics: more than 2 .8 million antibiotic-resistant infections occur in the United States each year, resulting in more than 35,000 deaths. The estimated cost of treating these infections is more than $4.6 billion per year.

“According to the report “Threats of Antibiotic Resistance in the United States in 2019” from the Centers for Disease Control and Preventions, threats are divided into urgency (Clostridioides difficile; carbapenem-resistant enterobacteriaceae; and drug resistant Neisseria gonorrhoeae,” Woo explained, “and serious. Serious threats include drug-resistant Candida; methicillin resistant Staphylococcus aureus; drug resistant Streptococcus pneumoniae; and drug-resistant tuberculosis. Additionally, threats of concern include group A and B streptococci, while a watch list includes Aspergillus fumigatus (azole resistant) and drug resistant Genital mycoplasma and Whooping cough Bordetella.

Woo also touched on some common childhood illnesses, acute otitis media (AOM) and bacterial sinusitis. “With AOM, the first line of antibiotics is high-dose amoxicillin; in the event of bacterial sinusitis, the first intention is amoxicillin at 45 mg/day. She then discussed second-line antibiotics as well as PCN allergy interventions for these two disorders. For AOM, she noted, the effectiveness of antibiotics ranged between 64% and 93%.

“Maybe it’s time to rethink the guidelines,” Woo noted, citing that the prevalence of S.pneumoniae primary pathogen has decreased from 40-45% in 1999 to 15-25% in 2017, and also noting that H flu. and M. catarrhalis are resistant to amoxicillin. Plus, Woo explained, a regular dose of amoxicillin-clavulanic acid will treat resistance. H flu. and M. catarrhalis, so there is no need for high-dose amoxicillin-clavulanic acid. She also offered antibiotic guidelines for community-acquired pneumonia (CAP), suggesting that shortened therapies for pediatric CAP might be sufficient. Woo also reviewed current and suggested antibiotic therapy for other well-known childhood conditions, such as strep throat; impetigo; and urinary tract infections.

The session concluded with tips for pediatric healthcare providers, including knowing which pathogen you are treating and prescribing appropriately; know your local resistance patterns; do not prescribe antibiotics for viral infections; correctly identify penicillin allergy; and consider an antibiotic stewardship program in your facility.

Woo T. Prescribing Antibiotics for Children in 2022. 43rd National Conference on Pediatric Health Care. March 22, 2022; Dallas, Texas.