With thanks to Global Health NOW, which reports: 'Pediatricians in Pakistan report high knowledge related to antibiotic usage, but limited training in antibiotic stewardship, per a survey in JAC-Antimicrobial Resistance; only 15% reported receiving training on antibiotic usage and AMR, and only 25.3% confirmed awareness of antimicrobial stewardship.'
Paediatricians’ knowledge, perceptions, preparedness and involvement towards paediatric antimicrobial stewardship in Pakistan: findings and the implications
Zia Ul Mustafa, Amer Hayat Khan, Muhammad Salman, Sabariah Noor Harun, Johanna C Meyer, Brian Godman
JAC-Antimicrobial Resistance, Volume 6, Issue 6, December 2024, dlae193, https://doi.org/10.1093/jacamr/dlae193
https://academic.oup.com/jacamr/article/6/6/dlae193/7919185
Abstract: Introduction: Antibiotics are frequently prescribed for neonates and children. However, this can be excessive with inappropriate prescribing leading to increased antimicrobial resistance (AMR). Paediatricians are key initiators of antibiotics. Consequently, their awareness, perceptions, readiness and potential barriers towards hospital-based antimicrobial stewardship programmes are of considerable importance, especially in Pakistan with high rates of AMR.
Materials and methods: A web-based cross-sectional survey among paediatricians from June to August 2023 using a validated questionnaire. Paediatricians from all four Provinces and the capital territory of Pakistan were invited from randomly selected public and private sector hospitals.
Results: 383 paediatricians participated (79.8% response rate). Most were male (87.7%), aged 35 years or less (55.4%), working in tertiary care hospitals (68.4%) and undertaking 51–100 child consultations every day (45%). Only 15% reported obtaining training on antibiotic usage, AMR and/or antimicrobial stewardship. Only 7.6% confirmed functional antimicrobial stewardship programmes in their institutions. Most had adequate knowledge of antibiotic use and AMR. However, key issues were not fully understood with only 27.4% believing antibiotics were being overused among children. Paediatricians with less experience, and who undertook fewer consultations per day, had significantly lower knowledge scores. Most participants were prepared to initiate antimicrobial stewardship programmes; however, perceived barriers included a lack of online learning sources, treatment guidelines and support from hospital administration.
Discussion: Paediatricians had appropriate knowledge about antibiotic use and AMR although concerns with antibiotic use. Important barriers to integrating antimicrobial stewardship programmes were identified, which need addressing for these to become routine.
COMMENT (NPW): The authors appear to base their statement 'Paediatricians had appropriate knowledge about antibiotic use' on YES/NO answers to the following 9 questions:
Antibiotics can be useful in treating viral infections
Antibiotics can cause secondary infections by killing normal flora
Antibiotics can cause allergic reactions
A resistant bacterium cannot spread in healthcare institutions
Skipping one or two doses does not contribute to the development of antibiotic resistance
Cross-resistance is the condition in which the resistance occurs to a particular antibiotic that often results in resistance to other antibiotics
Pain and inflammation without any possibility of infection are indications for antimicrobial therapy?
Are you aware of antibiotic resistance?
Are you aware of antibiotic stewardship? (only 25.3% of respondents claimed to be aware)
In my view the above questions do not indicate that 'Paediatricians had appropriate knowledge about antibiotic use'. At the very least, such knowledge should include an appreciation about what antibiotic to select in a range of different clinical contexts. Inappropriate prescribing of broad-spectrum antibiotics for conditions where a specific antibiotic would be more appropriate (as well as inappropriate prescribing of antibiotics where no antibiotic is indicated) are huge drivers of resistance. The fact that three-quarters of respondents were not even aware of antibiotic stewardship is particularly alarming.
There is also a problem in assessing knowledge by online questionnaire, where many of the respondents can find the 'right' answer by a quick internet search.
I look forward to comments from CHIFA members.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org