Prescribing antibiotics for kids in 2022

Rethinking antibiotic guidelines was the focus of this session at the 43rd National Conference on Pediatric Health Care for pediatric nurse practitioners in Dallas, Texas.

Teri Woo, PhD, ARNP, CPNP-PC, CNL, FAANP, professor and director of Nursing at Saint Martin’s University in Lacey, Washington, began her discussion on prescribing antibiotics with some compelling statistics: More than 2.8 million antibiotic-resistant infections occur in the US annually, resulting in more than 35,000 deaths. The estimated cost to treat these infections comes to more than $4.6 billion dollars annually.

“According to the Centers for Disease Control and Preventions’ “Antibiotic resistance threats in the US report in 2019,” threats are broken into urgent (Clostridioides difficile; carbapenem-resistant Enterobacteriaceae; and drug-resistant Neisseria gonorrhoeae,” explained Woo, “and serious.” Serious threats include drug-resistant Candida; methicillin-resistant Staphyloccoccus aureus; drug resistant Streptococcus pneumoniae; and drug-resistant tuberculosis. In addition, concerning threats include group A and B Streptococcus, while a watch list includes Aspergillus fumigatus (azole-resistant), and drug-resistant Mycoplasma genitalium and Bordetella pertussis.

Woo also discussed some common childhood illnesses, acute otitis media (AOM) and bacterial sinusitis. “With AOM, the first line of antibiotics is high-dose amoxicillin; with bacterial sinusitis, the first line is amoxicillin at 45 mg/day. She then discussed second line antibiotics as well as interventions for PCN allergies for these two disorders. For AOM, she noted, antibiotic effectiveness ranged between 64% and 93%.

“It might be time to rethink guidelines,” noted Woo, citing that the prevalence of S. pneumoniae primary pathogen has decreased from 40-45% in 1999 to 15-25% in 2017, and also noting that H. flu and M. catarrhalis are resistant to amoxicillin. Additionally, Woo explained, regular dose amoxicillin-clavulanate will treat resistant H. flu and M. catarrhalis, so there is no need for high dose amoxicillin-clavulanate. She also offered antibiotic guidelines for community-acquired pneumonia (CAP), suggesting shortened therapies for pediatric CAP may be sufficient. Woo also reviewed current and suggested antibiotic therapy for other well-known childhood conditions, such as strep pharyngitis; impetigo; and urinary tract infections.

The session concluded with tips for pediatric health care providers, including knowing what pathogen you are treating and prescribe appropriately; know your local resistance patterns; do not prescribe antibiotics for viral infections; appropriately identify penicillin allergy; and consider an antibiotic stewardship program at your facility.

Reference
Woo T. Prescribing antibiotics for kids in 2022. 43rd National Conference on Pediatric Health Care.March 22, 2022; Dallas, Texas.