scholarly journals Informing the development of a standardised approach to measure antibiotic use in secondary care: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026792
Author(s):  
Selina Patel ◽  
Arnoupe Jhass ◽  
Susan Hopkins ◽  
Laura Shallcross
Keyword(s):  
Secondary Care ◽  
Scale Up ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotic Usage ◽  
Prescribing Patterns ◽  
Primary Data ◽  
Antibiotic Prescribing ◽  
Cochrane Central Register ◽  
Antibiotic Consumption Surveillance

IntroductionEcological and individual-level evidence indicates that there is an association between level of antibiotic exposure and the emergence and spread of antibiotic resistance. The Global Point Prevalence Survey in 2015 estimated that 34.4% of hospital inpatients globally received at least one antimicrobial. Antimicrobial stewardship to optimise antibiotic use in secondary care can reduce the high risk of patients acquiring and transmitting drug-resistant infections in this setting. However, differences in the availability of data on antibiotic use in this context make it difficult to develop a consensus of how to comparably monitor antibiotic prescribing patterns across secondary care. This review will aim to document and critically evaluate methods and measures to monitor antibiotic use in secondary care.Methods and analysisWe will search Medline (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and websites of key organisations for published reports where an attempt to measure antibiotic usage among adult inpatients in high-income hospital settings has been made. Two independent reviewers will screen the studies for eligibility, extract data and assess the study quality using the Newcastle-Ottawa scale. A description of the methods and measures used in antibiotic consumption surveillance will be presented. An adaptation of the Affordability, Practicability, Effectiveness, Acceptability, Side-effects Equity framework will be used to consider the practicality of implementing different approaches to measuring antibiotic usage in secondary care settings. A descriptive comparison of definitions and estimates of (in)appropriate antibiotic usage will also be carried out.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. The results will be published in relevant peer-reviewed journals and presented at relevant conferences or meetings where possible. This review will inform future approaches to scale up antibiotic consumption surveillance strategies to attempt to maximise impact through standardisation.PROSPERO registration numberCRD42018103375

Antibiotic prescribing patterns among patients admitted to an academic teaching hospital for COVID-19 during the first wave of the pandemic in Toronto: A retrospective, controlled study

2021 ◽  
Author(s):  
Miranda So ◽  
Andrew M Morris ◽  
Alexander M Walker
Keyword(s):  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Community Acquired Pneumonia ◽  
Prescribing Patterns ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Antibiotic Prescribing ◽  
General Internal ◽  
Days Of Therapy ◽  
Empirical Antibiotics

Background: Empirical antibiotics are not recommended for coronavirus disease 2019 (COVID-19). Methods: In this retrospective study, patients admitted to Toronto General Hospital’s general internal medicine from the emergency department for COVID-19 between March 1 and August 31, 2020 were compared with those admitted for community-acquired pneumonia (CAP) in 2020 and 2019 in the same months. The primary outcome was antibiotics use pattern: prevalence and concordance with COVID-19 or CAP guidelines. The secondary outcome was antibiotic consumption in days of therapy (DOT)/100 patient-days. We extracted data from electronic medical records. We used logistic regression to model the association between disease and receipt of antibiotics, linear regression to compare DOT. Results: The COVID-19, CAP 2020, and CAP 2019 groups had 67, 73, and 120 patients, respectively. Median age was 71 years; 58.5% were male. Prevalence of antibiotic use was 70.2%, 97.3%, and 90.8% for COVID-19, CAP 2020, and CAP 2019, respectively. Compared with CAP 2019, the adjusted odds ratio (aOR) for receiving antibiotics was 0.23 (95% CI 0.10 to 0.53, p = 0.001) and 3.42 (95% CI 0.73 to 15.95, p = 0.117) for COVID-19 and CAP 2020, respectively. Among patients receiving antibiotics within 48 hours of admission, compared with CAP 2019, the aOR for guideline-concordant combination regimens was 2.28 (95% CI 1.08 to 4.83, p = 0.031) for COVID-19 and 1.06 (95% CI 0.55 to 2.05, p = 0.856) for CAP-2020. Difference in mean DOT/100 patient-days was –24.29 ( p = 0.009) comparing COVID-19 with CAP 2019, and +28.56 ( p = 0.003) comparing CAP 2020 with CAP 2019. Conclusions: There are opportunities for antimicrobial stewardship to address unnecessary antibiotic use.

ASSESSMENT OF ANTIBIOTIC USAGE PATTERN IN PATIENTS OF PEDIATRIC DEPARTMENT-A PROSPECTIVE STUDY

2021 ◽  
pp. 47-50
Author(s):  
MAHSA NAZI ◽  
MRS. ANISHA K. A. ◽  
NASIBEH GHANBARLOU
Keyword(s):  
Drug Prescription ◽  
Qualitative Evaluation ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotic Usage ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Usage Pattern ◽  
Pediatric Department ◽  
Health Organization

Objective: The study aimed to assess the antibiotic usage pattern in patients of the pediatric department in ESI Hospital, Indiranagar, Bangalore. Methods: A prospective six-month observational study was conducted in the pediatric department. The history of the patients was collected from the case sheets and the patient demographic details were also collected. The details of antibiotics prescribed and the other therapy applied to the patients were collected in terms of dosage, duration, and route of administration. The antibiotic consumption was assessed based on qualitative and quantitative indicators which assess the appropriateness of antibiotic use, and the dosage of antibiotics prescribed, respectively. Regarding the qualitative evaluation of antibiotic consumption, the World Health Organization (WHO) guideline was considered to appraise compliance with indication and dosing. Results: Distribution of drug prescription indicators showed that the average number of drugs per encounter was 3.7, which is more than the standards suggested by WHO and should be reduced as much as possible to mitigate polypharmacy and its consequences. 93.45% of encounters existed leastwise with one or more antibiotics, which was higher than the WHO standards. Almost 56.08% of drugs were prescribed considering their generic name, which was very much lower than the ideal percentage recommended by WHO. Conclusion: The percentage of encounters with one or more antibiotics was very higher than the WHO standard percentage, which indicates the irrationality of antibiotic prescribing. To minimize the irrationality of prescriptions and their inappropriateness, effective interventions and compliance with antibiotic prescribing guidelines are required.

scholarly journals An interdisciplinary mixed-methods approach to developing antimicrobial stewardship interventions: Protocol for the Preserving Antibiotics through Safe Stewardship (PASS) Research Programme

2020 ◽  
Vol 5 ◽  
pp. 8 ◽  
Author(s):  
Laura Shallcross ◽  
Fabiana Lorencatto ◽  
Christopher Fuller ◽  
Carolyn Tarrant ◽  
Jonathan West ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Systematic Reviews ◽  
Antimicrobial Stewardship ◽  
Secondary Care ◽  
Evidence Synthesis ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Care Homes ◽  
Antibiotic Prescribing ◽  
The Public

Behaviour change is key to combating antimicrobial resistance. Antimicrobial stewardship (AMS) programmes promote and monitor judicious antibiotic use, but there is little consideration of behavioural and social influences when designing interventions.  We outline a programme of research which aims to co-design AMS interventions across healthcare settings, by integrating data-science, evidence- synthesis, behavioural-science and user-centred design. The project includes three work-packages (WP): WP1 (Identifying patterns of prescribing):  analysis of electronic health-records to identify prescribing patterns in care-homes, primary-care, and secondary-care. An online survey will investigate consulting/antibiotic-seeking behaviours in members of the public. WP2 (Barriers and enablers to prescribing in practice): Semi-structured interviews and observations of practice to identify barriers/enablers to prescribing, influences on antibiotic-seeking behaviour and the social/contextual factors underpinning prescribing. Systematic reviews of AMS interventions to identify the components of existing interventions associated with effectiveness. Design workshops to identify constraints influencing the form of the intervention. Interviews conducted with healthcare-professionals in community pharmacies, care-homes, primary-, and secondary-care and with members of the public. Topic guides and analysis based on the Theoretical Domains Framework.  Observations conducted in care-homes, primary and secondary-care with analysis drawing on grounded theory.  Systematic reviews of interventions in each setting will be conducted, and interventions described using the Behaviour Change Technique taxonomy v1. Design workshops in care-homes, primary-, and secondary care. WP3 (Co-production of interventions and dissemination). Findings will be integrated to identify opportunities for interventions, and assess whether existing interventions target influences on antibiotic use. Stakeholder panels will be assembled to co-design and refine interventions in each setting, applying the Affordability, Practicability, Effectiveness, Acceptability, Side-effects and Equity (APEASE) criteria to prioritise candidate interventions.  Outputs will inform development of new AMS interventions and/or optimisation of existing interventions.  We will also develop web-resources for stakeholders providing analyses of antibiotic prescribing patterns, prescribing behaviours, and evidence reviews.

scholarly journals Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245902
Author(s):  
Kristina Skender ◽  
Vivek Singh ◽  
Cecilia Stalsby-Lundborg ◽  
Megha Sharma
Keyword(s):  
Design Patterns ◽  
Central India ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Essential Medicines ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Defined Daily Doses

Background Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients. Aim To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India. Methods Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups. Results Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02). Conclusion Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.

scholarly journals 966. A Closer Look at Antibiotic Prescribing for Upper Respiratory Illnesses (URI) in People with HIV Compared with People Without HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S31-S31
Author(s):  
Anum Abbas ◽  
Mackenzie R Keintz ◽  
Elizabeth Lyden ◽  
Jihyun Ma ◽  
Sara H Bares ◽  
...  
Keyword(s):  
Private Insurance ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Categorical Variables ◽  
Antibiotic Prescribing ◽  
Care Clinic ◽  
Antibiotic Overuse ◽  
Exact Test ◽  
Icd 10

Abstract Background Antibiotic overuse is widespread, increasing healthcare cost and promoting antimicrobial resistance. People with HIV (PWH) who develop URIs may be assumed “higher risk,” compared with non-PWH, but comparative antibiotic use evaluations have not been performed. We evaluated antibiotic prescribing patterns for URI diagnoses (cough, sinusitis, bronchitis, and cold) in PWH and non-PWH. Methods This was an observational, single-center study comparing PWH and non-PWH diagnosed with URI (using ICD 10 codes for URI syndromes: cough, sinusitis, bronchitis, and cold) between January 1, 2014 and April 30, 2018. Patients were empaneled in an outpatient primary care clinic or specialty care clinic in one healthcare system. Appropriateness of antibiotic prescribing was defined based on published guidelines. Fisher’s exact test compared categorical variables with antibiotic prescribing patterns. Each encounter was considered an independent event. Results The two groups (PWH and non-PWH) were similar, with 34% of subjects in both groups being female. PWH had median CD4+ count of 610 cells/mm3 with 91% on antiretrovirals and 77% with HIV RNA < 20 copies/mL. Overall, 37% of visits resulted in antibiotic prescriptions, 92% of which were inappropriate (discordant with guidelines). Antibiotics were prescribed slightly more frequently in non-PWH (40% vs. 33%, P = 0.056; Figure 1) and inappropriate more often in non-PWH (37% vs. 30%, P = 0.029). Over 20% of PWH antibiotic prescriptions were too long, and 22% of non-PWH received the wrong drug (Figure 2; P = 0.011). 47% of the non-PWH receiving antibiotics for URI had private insurance (compared with other payers; P < 0.0001) vs. 33% in PWH (P = 0.32) (Figure 3). Conclusion Outpatient antibiotic overuse remains prevalent among patients evaluated for URIs. This is the first study, to our knowledge, comparing antibiotic use for URIs in PWH compared with non-PWH. Counterintuitively, we found less-frequent inappropriate antibiotic use in PWH. We speculate that PWH are more likely to be evaluated by infectious disease/HIV specialists, possibly explaining the lower rate of antibiotic prescriptions for URIs in this population. Future analyses will evaluate the association between provider specialty and inappropriate antibiotic use. Disclosures All Authors: No reported Disclosures.

scholarly journals 1119. Implementation of Pediatric Antimicrobial Stewardship Rounds in a Children’s Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S398
Author(s):  
Natalie Tucker ◽  
Ezzeldin Saleh ◽  
Marcela Rodriguez
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Custom Made ◽  
Days Of Therapy ◽  
Before And After ◽  
The Individual

Abstract Background Antimicrobial stewardship programs (ASP) are required in all acute care hospitals per The Joint Commission. ASP must adhere to the recommendations laid out by the Centers for Disease Control and Prevention, but how each ASP chooses to implement these recommendations is left to the individual program. In January 2018, we began formal antimicrobial stewardship (AMS) walking rounds, led by infectious diseases trained physician and pharmacist, in our 99-bed pediatric hospital. Methods In January 2018, we started twice-weekly AMS rounds on the pediatric hospitalist service. A custom-made “Antimicrobial Stewardship Patient List” was designed in our electronic medical record (EMR) to generate a list of all patients receiving antibiotics. The ASP team (comprised of an infectious diseases pharmacist and a pediatric infectious diseases physician) reviewed EMR charts to determine antibiotic prescribing appropriateness and design recommended interventions. Any recommendations and teaching points were then discussed with the hospitalist team in person. After piloting the hospitalist service, AMS rounds were extended to include the general surgery patients and finally the intensive care unit. Data on number of charts reviewed, proposed interventions, and acceptance rates were collected throughout the process. Descriptive statistics were used to assess the intervention data. Results In the first year of the program, 427 patient charts were reviewed with 186 identified interventions. In total, 156 (84.3%) of the interventions were accepted and implemented by the primary team. The most common types of interventions were the duration of therapy (29%), antibiotic discontinuation (16.7%), intravenous to oral conversion (11.3%), de-escalation (10.2%), and infectious diseases consult (5.9%). Conclusion Pediatric AMS rounds led to the successful implementation of the majority of recommended interventions. Future goals of the program include calculating days of therapy per 1000 patient-days to assess antibiotic consumption before and after AMS rounds and to expand into other services to further promote appropriate antibiotic use in hospitalized pediatric patients. Disclosures All authors: No reported disclosures.

Antibiotics Utilization for Community Acquired Pneumonia in a Community Hospital Emergency Department

2020 ◽  
pp. 089719002095303
Author(s):  
Jessica Yu ◽  
Gillian Wang ◽  
Ann Davidson ◽  
Ivy Chow ◽  
Ada Chiu
Keyword(s):  
Emergency Department ◽  
Community Hospital ◽  
Community Acquired Pneumonia ◽  
Antibiotic Usage ◽  
Prescribing Patterns ◽  
Local Health Authority ◽  
Antibiotic Prescribing ◽  
Local Health ◽  
Moderate Severity ◽  
Stewardship Program

Background: A local health authority in Canada implemented its own Antimicrobial Stewardship Program (ASP) which provide guidelines to clinicians to utilize when treating infectious diseases such as community-acquired pneumonia (CAP). Objectives: The primary objective is to describe antibiotic usage patterns at the community hospital’s emergency department (ED) and to analyze the patterns in relation to ASP goals of reducing risk of infections, adverse drug events and antibiotic resistance, and to identify potential areas of improvement. Methods: This retrospective chart review included 156 adult patients with a diagnosis of CAP admitted to a community hospital ED from December 1, 2015 to November 30, 2016. Results: 50.6% patients were prescribed moxifloxacin across all severity of CAP patients. Low and moderate severity CAP patients were most often prescribed antibiotic duration > 7 days. In low, moderate and high severity CAP patients who were treated using ceftriaxone, 100%, 88.9% and 66.6% patients were treated with ceftriaxone 2000 mg daily respectively. Conclusions: Antibiotic prescribing patterns suggest fluoroquinolones were frequently being over-prescribed, ceftriaxone dosages were often too high, and duration of antibiotics for low and moderate severity CAP were too long. More efforts are needed to promote appropriate antibiotic usage and optimize patient care.

scholarly journals Diarrhoea and preadmission antibiotic exposure in COVID-19: a retrospective cohort study of 1153 hospitalised patients

2021 ◽  
Vol 8 (1) ◽  
pp. e000593
Author(s):  
Bilal Akhter Mateen ◽  
Sandip Samanta ◽  
Sebastian Tullie ◽  
Sarah O’Neill ◽  
Zillah Cargill ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Antibiotic Exposure ◽  
Test Results ◽  
Risk Of Mortality ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Residual Confounding

ObjectiveThe aims of this study were to describe community antibiotic prescribing patterns in individuals hospitalised with COVID-19, and to determine the association between experiencing diarrhoea, stratified by preadmission exposure to antibiotics, and mortality risk in this cohort.Design/methodsRetrospective study of the index presentations of 1153 adult patients with COVID-19, admitted between 1 March 2020 and 29 June 2020 in a South London NHS Trust. Data on patients’ medical history (presence of diarrhoea, antibiotic use in the previous 14 days, comorbidities); demographics (age, ethnicity, and body mass index); and blood test results were extracted. Time to event modelling was used to determine the risk of mortality for patients with diarrhoea and/or exposure to antibiotics.Results19.2% of the cohort reported diarrhoea on presentation; these patients tended to be younger, and were less likely to have recent exposure to antibiotics (unadjusted OR 0.64, 95% CI 0.42 to 0.97). 19.1% of the cohort had a course of antibiotics in the 2 weeks preceding admission; this was associated with dementia (unadjusted OR 2.92, 95% CI 1.14 to 7.49). After adjusting for confounders, neither diarrhoea nor recent antibiotic exposure was associated with increased mortality risk. However, the absence of diarrhoea in the presence of recent antibiotic exposure was associated with a 30% increased risk of mortality.ConclusionCommunity antibiotic use in patients with COVID-19, prior to hospitalisation, is relatively common, and absence of diarrhoea in antibiotic-exposed patients may be associated with increased risk of mortality. However, it is unclear whether this represents a causal physiological relationship or residual confounding.

scholarly journals From Point-of-Care Testing (PoCT) and vaccination to changing the care paradigm: the role of primary care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Petelos ◽  
C Lionis
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Point Of Care ◽  
Behavioural Change ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Prescribing Patterns ◽  
Patient Treatment ◽  
Therapeutic Decisions

Abstract The speaker will discuss the role of primary care for all patients and cancer patients, elaborating on prescribing patterns vaccinations, recommendations for Over-The-Counter medicines (OTCs) nutritional supplements, and as well as its contribution of behavioural change to raise awareness and change prescription practice. The role of PoCT for reducing the threat of AMR and for improving the differential diagnosis will be discussed, according to the WHO Approach of “diagnostic stewardship” for the appropriate use of microbiological diagnostics to guide therapeutic decisions. In the context of syndromic surveillance and preparedness, as well as in terms of protecting cancer patients at times of epidemics, methods of specimen collection for limited community transmission and for the timely pathogen identification along with accurate, timely reporting of results to guide patient treatment will be discussed. The role of behavioural modification interventions will be discussed, incl. in relation to vaccination and the role it can play in AMR. Improvement of the survivorship experience will be examined in the context of improving health literacy. The case of Greece, currently having the highest antibiotic consumption in Europe and the fourth highest globally, along with an increasing trend on antibiotic use will also be discussed.

scholarly journals Antibiotic Use Among Hospitalized Children and Neonates in China: Results From Quarterly Point Prevalence Surveys in 2019

2021 ◽  
Vol 12 ◽  
Author(s):  
Chu-ning Wang ◽  
Jianning Tong ◽  
Bin Yi ◽  
Benedikt D. Huttner ◽  
Yibing Cheng ◽  
...  
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Antibiotic Use ◽  
Point Prevalence ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Hospitalized Children ◽  
Prevalence Survey ◽  
Common Diagnosis ◽  
Tract Infections ◽  
The Impact

Background: Antimicrobial resistance is a significant clinical problem in pediatric practice in China. Surveillance of antibiotic use is one of the cornerstones to assess the quality of antibiotic use and plan and assess the impact of antibiotic stewardship interventions.Methods: We carried out quarterly point prevalence surveys referring to WHO Methodology of Point Prevalence Survey in 16 Chinese general and children’s hospitals in 2019 to assess antibiotic use in pediatric inpatients based on the WHO AWaRe metrics and to detect potential problem areas. Data were retrieved via the hospital information systems on the second Monday of March, June, September and December. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions and ward types according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) Classification.Results: A total of 22,327 hospitalized children were sampled, of which 14,757 (66.1%) were prescribed ≥1 antibiotic. Among the 3,936 sampled neonates (≤1 month), 59.2% (n = 2,331) were prescribed ≥1 antibiotic. A high percentage of combination antibiotic therapy was observed in PICUs (78.5%), pediatric medical wards (68.1%) and surgical wards (65.2%). For hospitalized children prescribed ≥1 antibiotic, the most common diagnosis on admission were lower respiratory tract infections (43.2%, n = 6,379). WHO Watch group antibiotics accounted for 70.4% of prescriptions (n = 12,915). The most prescribed antibiotic ATC classes were third-generation cephalosporins (41.9%, n = 7,679), followed by penicillins/β-lactamase inhibitors (16.1%, n = 2,962), macrolides (12.1%, n = 2,214) and carbapenems (7.7%, n = 1,331).Conclusion: Based on these data, overuse of broad-spectrum Watch group antibiotics is common in Chinese pediatric inpatients. Specific interventions in the context of the national antimicrobial stewardship framework should aim to reduce the use of Watch antibiotics and routine surveillance of antibiotic use using WHO AWaRe metrics should be implemented.

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