Antibiotic overprescribing among neonates and children hospitalized with COVID-19 in Pakistan and the implications

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Mustafa, Zia Ul and Khan, Amer Hayat and Harun, Sabariah Noor and Salman, Muhammad and Godman, Brian (2023) Antibiotic overprescribing among neonates and children hospitalized with COVID-19 in Pakistan and the implications. Antibiotics, 12 (4). 646. ISSN 2079-6382 (https://doi.org/10.3390/antibiotics12040646)

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Abstract

There are concerns with excessive antibiotic prescribing among patients admitted to hospital with COVID-19 increasing antimicrobial resistance (AMR). Most studies have been conducted in adults with limited data on neonates and children including in Pakistan. A retrospective study was conducted among four referral/tertiary care hospitals including the clinical manifestations, la-boratory findings, the prevalence of bacterial co-infections or secondary bacterial infections and antibiotics prescribed among neonates and children hospitalized due to COVID-19. Among 1237 neonates and children, 511 were admitted to the COVID-19 wards and 433 were finally included in the study. The majority of admitted children were COVID-19 positive (85.9%) with severe COVID-19 (38.2%), and 37.4% were admitted to ICU. The prevalence of bacterial co-infections or secondary bacterial infections was 3.7%; however, 85.5% were prescribed antibiotics during their hospital stay (average 1.70 ± 0.98 antibiotics per patient). 54.3% were prescribed two antibiotics via the parenteral route (75.5%) for ≤ 5 days (57.5), with most being ‘Watch’ antibiotics (80.6%). In-creased antibiotic prescribing was reported among patients requiring mechanical ventilation and high WBCs, CRP, D-Dimer and ferritin levels (p < 0.001). Increased COVID-19 severity, length of stay and hospital setting were significantly associated with antibiotic prescribing (p < 0.001). Ex-cessive antibiotic prescribing among hospitalized neonates and children despite very low bacterial co-infections or secondary bacterial infections requires urgent attention to reduce AMR.

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