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Table 2 Main studies on the impact of antimicrobial stewardship programs in paediatric settings

From: Antimicrobial stewardship in paediatrics

Author and year of publication

Site of evaluation

Strategy

Type of control

Main results

Agwu et al., 2008 [36]

Single hospital

World Wide Web-based antimicrobial restriction program, automated clinical decision support, facilitated approval, enhanced real-time communication among prescribers, pharmacists, and paediatric infectious disease fellows

Before and after implementation of the program, evaluation of user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times and costs

Satisfaction increased from 22–68 % and from 13–69 % among prescribers and pharmacists, respectively. Reductions of 21 % and 32 % in the number of missed and delayed antimicrobial doses, respectively

$370,069 reduction in projected annual costs

Metjian et al., 2008 [37]

Single hospital

Evaluation of outcomes and compliance resulting from empirical antibiotic therapy decisions

Intervention to modify antibiotic therapy

45 % of prescriptions required an intervention.

Di Pentima et al., 2011 [38]

Single hospital

Antimicrobial use indications were included as a mandatory field in the computerized information system

Prescriptions were reviewed by specialists

Reduction in antimicrobials of more than 30 % for both targeted and nontargeted drugs

Hersh et al., 2015 [39]

Nine hospitals

Antimicrobial consumption after introduction of an antimicrobial stewardship program defined as a program able to continuously monitor use with the support of a dedicated team in some hospitals

Evaluation of days of therapy per 1,000 patient-days

Decline in average antibiotic use in hospitals with antimicrobial stewardship program of 11 % vs 8 % in those without the program

Filkelstein et al., 2008 [40]

The community (16 non-overlapping communities)

Guideline dissemination, small-group education, frequent updates, education material for paediatricians and parents

Consumption of antibiotics

The intervention had no effect among children aged 3–23 months but was associated with a 4 % and 7 % decrease in antibiotic prescriptions in those aged 24–47 months and 48–71 months, respectively.

Gerber et al., 2013 [41]

The community (162 clinicians)

One 1-h on-site education session followed by one year of personalized quarterly audits and feedback on prescriptions for respiratory infections or usual practice in a group of enrolled individuals

Consumption of antibiotics

Broad spectrum antibiotic prescriptions decreased from 27 % to 14 % among intervention practices and from 28 % to 23 % in controls.

Off-guideline prescriptions decreased from 16 % to 4 % among intervention practices compared with a decrease from 17 % to 16 % in controls.