Implementation of Hospital’s Antibiotic Policy Decreases Antimicrobial Use in the General Pediatric Ward

  • Aneta Nitsch-OsuchEmail author
  • E. Kuchar
  • K. Życińska
  • E. Gyrczuk
  • K. Miśkiewicz
  • K. Korzeniewski
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 857)


Hospitalized children are often treated with antibiotics. However, 30–75 % of antibiotic treatment in pediatric hospitals is administrated incorrectly or unreasonably. Implementation of Hospital’s Antibiotic Policy (HAP) should improve antibiotic consumption patterns in pediatric wards. The objective of this study was to determine the effectiveness of HAP by assessing antibiotic consumption in the General Pediatric Ward of an academic hospital in the city of Warsaw, Poland before and after this policy was introduced in the years 2012 and 2013, respectively. Antibiotic use was calculated in daily-defined doses (DDDs) per 100 patient-days and DDDs per 100 admissions. Antibiotics were ranked by the volume of DDDs and the number of antibiotics which accounted for 90 % and 100 % of the total volume: DU90% and DU100% (where DU stands for drug use). The total antibiotic consumption and significantly decreased after the implementation of HAP; DDDs were 2,177.5 before and 1,335.4 after implementation of HAP. The number of DDDs/100 patient-days was also lower; 36.3 vs. 24.9 before and after HAP, respectively. After implementation of HAP a decreased use of ceftriaxone and cefuroxime was observed. The most commonly used antibiotic was amoxicillin with clavulanic acid. The DU100% rates remained the same (8 antibiotics) and DU90% increased (from 3 in 2012 to 5 in 2013). We conclude that implementation of HAP resulted a decreased consumption of antibiotics in the General Pediatric Ward, despite the hardly changed number of children treated with antibiotics.


Antimicrobials Antibiotics Drug utilization Policy Stewardships 



American Academy of Pediatrics


Anatomical Therapeutic Chemical Classification


Community-acquired pneumonia


Centers for Disease Control and Prevention


Daily-defined doses


90 % drug utilization


100 % drug utilization


Infectious Diseases Society of America


Hospital Antibiotic Policy


National Program of Antibiotic Protection


Pediatric Infectious Disease Society


Society of Healthcare Epidemiology of America


World Health Organization


Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.


  1. Ang L, Laskar R, Gray JW (2008) A point prevalence study of infection and antimicrobial use at a UK children’s hospital. J Hosp Infect 68:372–374PubMedCrossRefGoogle Scholar
  2. Atti ML, Raponi M, Tozzi E, Ciliento G, Ceradini J, Langiano T (2008) Point prevalence study of antibiotic use in a paediatric hospital in Italy. Eurosurevillance 13:1–4Google Scholar
  3. Benin AL, Vitkauskas G, Thornquist E (2003) Improving diagnostic testing and reducing overuse of antibiotics for children with pharyngitis: a useful role for the electronic medical record. Pediatr Infect Dis J 22:1043–1047PubMedCrossRefGoogle Scholar
  4. Bergman U, Popa C, Tomson Y (1998) Drug utilization 90% – a simple method for assessing the quality of drug prescribing. Eur J Clin Pharmacol 54:113–118PubMedCrossRefGoogle Scholar
  5. Berild D, Abrahamsen TG, Andresen S, Bjørløw E, Haug O, Kossenko IM (2008) A controlled intervention study to improve antibiotic use in a Russian paediatric hospital. Int J Antimicrob Agents 31:478–483PubMedCrossRefGoogle Scholar
  6. Blinova E, Lau E, Bitnun A, Cox P, Schwartz S, Atenafu E, Yau Y, Streitenberger L, Parshuram C, Marshall J, Seto W (2013) Point prevalence survey of antimicrobial utilization in the cardiac and pediatric critical care. Pediatr Crit Care Med 14:280–288CrossRefGoogle Scholar
  7. Bradley JS, Byington CL, Shah SS (2011) The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 53:e25–e76PubMedCrossRefGoogle Scholar
  8. Bruce CM, Kenzie FM, Cookson B, Mollison J, van der Meer J, Kracmery V, Dould I (2009) Antibiotic stewardship and consumption: findings from a pan-European hospital study. J Antimicrob Chemother 64:853–860PubMedCrossRefGoogle Scholar
  9. Cars O, Molstad S, Melander A (2001) Variation in antibiotic use in the European Union. Lancet 357:1851–1853PubMedCrossRefGoogle Scholar
  10. Centers for Disease Control and Prevention (CDC) (2012) Get smart: know when antibiotics work. For healthcare providers. Centers for Disease Control and Prevention. Accessed on 1 Oct 2014
  11. de Boeck K, Vermeulen F, Meyts I, Hutsebaut L, Franckaert D, Proesmans M (2011) Coprescription of antibiotics and asthma drugs in children. Pediatrics 127:1022–1026PubMedCrossRefGoogle Scholar
  12. de Man P, Verhoeven BA, Verbrugh HA, Vos MC, van den Anker JN (2000) An antibiotic policy to prevent emergence of resistant bacilli. Lancet 355:973–978PubMedCrossRefGoogle Scholar
  13. di Pentima M, Chan S, Hossain J (2011) Benefits of a pediatric antimicrobial stewardship program at a children’s hospital. Pediatrics 128:1062–1070PubMedCrossRefGoogle Scholar
  14. Gaur AH, Hare ME, Shorr RI (2005) Provider and practice characteristics associated with antibiotic use in children with presumed viral respiratory tract infections. Pediatrics 115:635–641PubMedCrossRefGoogle Scholar
  15. Grohskopf L, Huskins W, Sinkowitz-Cochran R, Levine G, Goldmann D, Jarvis W (2005) Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis 24:766–773CrossRefGoogle Scholar
  16. Hajdu A, Samodova OV, Carlsson TR, Voinova LV, Nazarenko SJ, Tjurikov AV (2007) A point prevalence survey of hospital-acquired infections and antimicrobial use in a paediatric hospital in north-western Russia. J Hosp Infect 66:378–384PubMedCrossRefGoogle Scholar
  17. Hryniewicz W, Ozorowski T (2011) Hospital antibiotic policy. Proposals for Polish hospitals. Accessed on 12 July 2014
  18. Hyun D, Hersh A, Namtu K, Palazzi D, Maples D, Newland J, Saiman L (2013) Antimicrobial stewardship in pediatrics. How every pediatrician can be a steward. J Am Med Assoc Pediatr 167:859–866Google Scholar
  19. Katakam P, Elfituri A, Ramadan Z, Abadi O (2012) A retrospective study on antibiotic use in different clinical departments of a teaching hospital in Zawiya, Libya. Ibnosina J Med Biomed Sci 12:13–19Google Scholar
  20. Kuster SP, Ruef C, Ledergerber B (2008) Quantitative antibiotic use in hospitals: comparison of measurements, literature review, and recommendations for a standard of reporting. Infection 36:549–559PubMedCrossRefGoogle Scholar
  21. Levy E, Swami S, Dubois S, Wendt R, Banerjee R (2012) Rates and appropriateness of antimicrobial prescribing at the academic children’s hospital, 200702010. Infect Control Hosp Epidemiol 33:346–353PubMedCrossRefGoogle Scholar
  22. Liem TB, Krediet T, Fleer A, Agberts T, Rademaker C (2010) Variation in antibiotic use in neonatal intensive care units in the Netherlands. J Antimicrob Chemother 14:245–247Google Scholar
  23. National Programme for Antibiotic Prevention (NPAP) (2011) Accessed on 12 Oct 2014
  24. Nitsch-Osuch A, Kurpas D, Kuchar E, Życińska K, Wardyn K (2015) Antibiotic consumption pattern in the neonatal special care unit before and after implementation of the Hospital’s Antibiotic Policy. Adv Exp Med Biol 835:45–51PubMedGoogle Scholar
  25. Ohl C, Luther V (2011) Antimicrobial stewardship for inpatient facilities. J Hosp Med 11:S4–S15CrossRefGoogle Scholar
  26. Palcevski G, Ahel V, Vlahovic-Palcevski V (2004) Antibiotic use profile at paediatric clinics in two transitional countries. Pharmacoepidemiol Drug Saf 13:181–185PubMedCrossRefGoogle Scholar
  27. Papaevangelou V, Rousounides A, Hadjipanagis A, Katsioulis A, Theodoridou M, Hadjichristodoulou C (2012) Decrease of antibiotic consumption in children with upper respiratory tract infections after implementation of an intervention program in Cyprus. Antimicrob Agent Chemother 56:1658–1661CrossRefGoogle Scholar
  28. Potocki M, Goette J, Szucs TD, Nadal D (2003) Prospective survey of antibiotic utilization in pediatric hospitalized patients to identify targets for improvement of prescription. Infection 31:398–403PubMedGoogle Scholar
  29. Principi N, Marchisio P, Sher D, Boccazzi A, Moresco RC, Viola G, Sereni F (1981) Control of antibiotic therapy in paediatric patients. II. Appropriateness of antibiotic choice in selected diseases. Eur J Clin Pharmacol 20:119–121PubMedCrossRefGoogle Scholar
  30. Rossignoli A, Clavenna A, Bonati M (2007) Antibiotic prescription and prevalence rate in the outpatient pediatric population: analysis of surveys published during 2000–2005. Eur J Clin Pharmacol 63:1099–1106PubMedCrossRefGoogle Scholar
  31. Schollenberg E, Albritton WL (1980) Antibiotic misuse in a pediatric teaching hospital. Can Med Assoc J 122:49–52PubMedCentralPubMedGoogle Scholar
  32. Shehab N, Patel PR, Srinivasan A, Budnitz DS (2008) Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 47:735–743PubMedCrossRefGoogle Scholar
  33. Stallworth LE, Fick DM, Ownby DR, Waller JL (2005) Antibiotic use in children who have asthma: results of retrospective database analysis. J Manag Care Pharmacol 11:657–666Google Scholar
  34. Stichele RH, Elseviers MM, Ferech M, Blot S, Goossens H, European Surveillance of Antibiotic Consumption (ESAC) Project Group (2006) Hospital consumption of antibiotics in 15 European countries: results of the ESAC Retrospective Data Collection (1997–2002). J Antimicrob Chemother 58:159–167CrossRefGoogle Scholar
  35. Svestina I, Mozgis D (2014) Antimicrobial use among hospitalized children in Latvia: a neonatal and pediatric antimicrobial point prevalence study. Medicine 12:111–119Google Scholar
  36. van Houten MA, Luinge K, Laseur M, Kimpen JL (1998) Antibiotic utilization for hospitalized paediatric patients. Int J Antimicrob Agents 10:161–164PubMedCrossRefGoogle Scholar
  37. Zhang W, Shen X, Bergman U (2008) Drug utilization 90% (DU90%) profiles of antibiotics in five Chinese children’s hospitals (2002–2006). Int J Antimicrob Agents 32:250–255PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Aneta Nitsch-Osuch
    • 1
    Email author
  • E. Kuchar
    • 2
  • K. Życińska
    • 1
  • E. Gyrczuk
    • 1
  • K. Miśkiewicz
    • 2
  • K. Korzeniewski
    • 3
  1. 1.Department of Family MedicineWarsaw Medical UniversityWarsawPoland
  2. 2.Department of Pediatric Infectious DiseasesWroclaw Medical UniversityWarsawPoland
  3. 3.Department of Epidemiology and Tropical MedicineMilitary Institute of MedicineWarsawPoland

Personalised recommendations