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

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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