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