Policy sharing for the rational use of antibiotics in paediatrics

IntroductionThe rational use of antibiotics in the treatment of infectious diseases is particularly critical for paediatric patients because of their physiological characteristics, such as the incomplete development of the immune system and the development of organ functions. Improper use of antibiotics may not only affect the current health of the infected child, but may also adversely affect its long-term growth and development. It is therefore important to develop and implement policies for the rational use of antibiotics in paediatrics in order to guarantee child health and reduce the risks associated with antibiotics.II. Status and problems with paediatric antibiotics(i) Overuse1. Prevention of excessive useIn paediatric clinical practice, some doctors also use antibiotics to prevent potential infections in non-necessary situations. For example, in cases of common influenza (mostly caused by viruses), antibiotics are still prevented when there is no evidence of a combination of bacterial infections. Such excessive preventive use increases exposure to unwanted drugs for children and increases the risk posed by drug-resistant bacteria.2. Empirical use blindPaediatricians often rely on experiential medication in the face of an emergency or a child with an unusual condition. At times, however, the distribution of common pathogens and drug resistance in the region and in the hospital has not been adequately considered. For example, in a region with high resistance to penicillin, penicillin is still used frequently to treat children suspected of contracting streptococcus, resulting in poor treatment and delays.(ii) MisuseImproper choice of drugsAppropriate antibiotics are not selected, depending on the age of the child, the area of infection and the severity of the condition. For example, in the case of new-born infections, drugs that may impair the function of the liver and kidney are used, or antibiotics that are effective in concentrations and sensitive to pathogens are not selected for urinary system infections.2. Irregular dosage and treatment processThe dose of paediatric antibiotics needs to be calculated accurately on the basis of the child ‘ s weight, age, etc., but the dose is inaccurate. Some doctors may not have strictly adjusted the dose to weight, resulting in underdoses or overdoses. In terms of treatment, there is the problem of long or short medication. Longer use of the drug can cause herb disorders, drug resistance, etc., while short use of the drug can lead to re-emergence.III. Policy content for the rational use of antibiotics in paediatrics(i) Strict control over the use of indicators1. Distinguishing types of infectionAntibiotics are not used for viral infectious diseases such as common flu, most upper respiratory infections (except for secondary bacterial infections), rotavirus enteritis, etc. The use of antibiotics is considered only when it is clearly diagnosed as a bacterial infection or as a basis for a high level of suspicion of bacterial infection, e.g. heat corrosive white cell rise, C reaction protein rise, calcium reduction rise, etc., combined with clinical symptoms and signs.2. Special circumstances considerationsFor some children with low immune functions (e.g. congenital immunodeficiency syndrome, chronic use of immunosuppressants, etc.), where there are signs of slight infections, the use of antibiotics can be appropriately relaxed, but careful assessment and close observation of changes in conditions is still required.(ii) Reasonable choice of antibiotics1. Choice by ageThe resistance and metabolic capacity of paediatric patients of different ages varies. During the neonatal period, the use of drugs such as chloroacin and amino sugar slurry that may impair liver and kidney function and hearing should be avoided. During infancy and early childhood, for common respiratory infections, highly safe and suitable antibacterial drugs, such as Amosicillin, Head Clow, etc., are available. In the case of childhood infections, the choice of drugs, e.g., fungus appropriates for urinary system infections, etc., is based on the area of infection and possible pathogens.2. Based on infected areas and pathogensThe common pathogens of respiratory infections are streptococcus, flu haemophilus influenzae, etc., and can be selected from the Amosilin-Clavicate potassium, sepsis, etc. In the case of intestinal tract infections caused by bacteria, such as salmonella, three generations of sepsis are optional. Skin soft tissue infections, with the option of benzosicillin and so on for golden grapes. At the same time, priority is given to sensitive antibiotics, taking into account the region ‘ s pathogen resistance monitoring data.(iii) Accurate calculation of dosages and standard procedures1. Dose calculationThe appropriate formula is used to accurately calculate the weight of the infected child and to determine the dose of antibiotics based on the weight, age and dose range recommended in the drug instructions or clinical guidelines. For obese or wasting children, the dose can be further adjusted by combining, for example, the surface area. For some antibiotics requiring precise control of blood drug concentrations, such as vancomycin, blood drug concentration monitoring can guide dose adjustments.2. Course determinationIn the case of acute infections, it is generally considered to stop after normal infant temperature and abating symptoms 3-5 days, but for serious infections (e.g. sepsis, meningitis, etc.), the use of antibiotics 1 – 2 weeks or longer is required after the symptoms have disappeared, depending on the condition and the elimination of the pathogens. In the course of treatment, changes in the condition of a child are closely observed, and the effects of treatment are assessed and the decision to stop the drug is taken by reviewing indicators such as blood protocol, C reaction protein, calcium reduction.IV. Policy implementation and oversight mechanisms(i) Training and education of doctors1. Ongoing training programmeHospitals should develop long-term training programmes for paediatricians in the rational use of antibiotics. Topical lectures, seminars, etc. are organized on a regular basis, and experts in infectious sciences and pharmacology are invited to provide up-to-date antibiotics, including introductions of new drugs, interpretation of results of drug resistance surveillance, analysis of cases of drug adverse effects, etc. The training should be integrated with actual clinical cases and enhance the learning interest and application of doctors.2. Online learning platform and appraisalAn online learning platform providing a wealth of learning materials, such as e-books, academic papers, video courses, etc., to facilitate children ‘ s studies at all times. At the same time, periodic examinations are conducted, which include theoretical knowledge and clinical practice applications. The results of the examination are linked to the doctor ‘ s performance, promotion, etc., and encourage him to actively study and improve the proper use of antibiotics.(ii) Real-time monitoring and feedback1. Establishment of a monitoring system for the use of paediatric antibioticsThe hospital information system was used to establish a monitoring module for paediatric antibiotics. The system allows for real-time recording of basic information, diagnosis, name of antibiotics used, dosage, time of delivery, course of treatment, etc. The use of abnormal antibiotics, such as overdoses, ultratherapy, irrational combinations, etc., is detected in a timely manner through large data analysis techniques.Feedback and improvement measuresMonitoring results are regularly fed back to paediatricians and section managers. One-on-one communication and guidance are provided to doctors who have problems with the unreasonable use of antibiotics to help them analyse the causes of the problem and develop measures for improvement. Group discussions and training are organized to adapt clinical drug norms to prevailing problems.(iii) Multidisciplinary collaboration and communication1. Paediatrics and pharmacologyThe Pharmacy Department arranges for clinical pharmacists to participate in paediatric clinical work, including house searches, consultations, etc. Clinical pharmacists can assist paediatricians in developing sound antibiotic treatment programmes and provide professional advice on the choice of drugs, dosage adjustments, drug interactions, etc. For example, when children suffer from multiple drug use at the same time, clinical pharmacists can assess whether there are drug interactions that affect the efficacy of antibiotics or increase the risk of adverse reactions, and adjust drug programmes in a timely manner.2. Communication with microbiology laboratoriesPaediatricians should strengthen contact with microbiology laboratories. Microbiological laboratories should conduct pathogen culture and drug-sensitization tests as soon as possible upon receipt of an infested child specimen, and provide timely and accurate feedback to doctors. In the case of suspected complex infections, microbial laboratory technicians can discuss with paediatricians the selection of appropriate testing methods, improve the detection rate of pathogens and the accuracy of drug-sensitive tests, and provide a basis for accurate drug use.ConclusionsThe implementation of the policy on the rational application of antibiotics in paediatrics requires a number of efforts and synergies. The rational use of paediatric antibiotics and the generation of antibiotic-related adverse effects and drug-resistant bacteria can be effectively improved through the clear use of indicators, rational choice of drugs, accurate quantification of doses and standardized treatment, and well-established implementation and monitoring mechanisms. This is crucial for ensuring the health of paediatric patients and the improvement of the quality of medical care, while also providing a good basis for the sustainable development of paediatric care.