• Parents can use the new guidelines to prompt doctors about the duration of antibiotic courses. (SBS)Source: SBS
Doctors can stop antibiotics sooner in children, helping them to leave hospital earlier and fight antibiotic resistance, according to the experts behind a new set of clinical guidelines for prescribing.
By
Yasmin Noone

17 Jun 2016 - 8:39 AM  UPDATED 17 Jun 2016 - 8:39 AM

Parents who are concerned about the amount of antibiotics their sick child consumes can now rest assured. Doctors will have access to a new set of guidelines, recommending that they take children off antibiotics sooner and release them from hospital earlier than before.

Australian and New Zealand experts have worked together to develop a new chink in the armour against global antibiotic resistance, with a new study advising against doctors keeping children in hospital on intravenous or oral antibiotics for too long.

The research, published in the Lancet Infectious Diseases today, looks at 36 bacterial infections in children that typically require hospitalisation and antibiotics, and provides practical and evidence-based advice on when doctors can shorten courses of antibiotics to help in the fight against resistance.

“We’ve shown that in most conditions, we can stop antibiotics sooner than in traditionally long courses and do that safely,” explains co-author of the national guidelines, Associate Professor Penelope Bryant from Murdoch Childrens Research Institute (MCRI).

“So parents can now be advocates for their children and ask their doctor in hospital or their GP if their child is sent home, ‘when can my child stop antibiotics?’”

“Now this may seem like a small difference but when you look at all the children around Australia and the amount of days they save being in hospital because of new guidelines, the result is important."

A/Prof Bryant says the study highlights the need for guidelines as it found that traditional courses of antibiotics for people under age 18 are often prescribed for too long.

“Antibiotics, intravenous and oral, are usually given to children with skin infections for 10 days when they only need to be given for five days. That’s longer than the necessary duration. For pneumonia, children are given antibiotics, intravenous and oral, for seven days when they only need them for five.

“Now this may seem like a small difference but when you look at all the children around Australia and the amount of days they save being in hospital because of new guidelines, the result is important.

“And as a parent, I can tell you that any days you can save your children staying in hospital by getting them out sooner is an advantage.”

The guidelines were written on behalf of the Australian and New Zealand Paediatric Infectious Diseases - Australasian Stewardship of Antimicrobials in Paediatrics (ANZPID-ASAP) group.

They contain various symptoms that act as pointers as to when doctors should step down or stop antibiotic use in children. For example, it shows that reasons to change from antibiotics via a drip to oral antibiotics include a reduction in fever and clinical improvement with or without supporting test results.

“And as a parent, I can tell you that any days you can save your children staying in hospital by getting them out sooner is an advantage.”

A previous study examining the use of antibiotics for hospitalised Australian children, published in 2014, shows that 82 per cent of antibiotic prescriptions were appropriate, but this varied widely between hospitals (65 per cent to 94 per cent) and specialties.

Among surgical patients, 35 per cent of all antimicrobial prescriptions were considered inappropriate, mostly because of excessive duration.

A/Prof Bryant is hopeful that doctors will adopt the guidelines and shorten antibiotic course duration for children when appropriate.

The Australian Medical Association (AMA) was contacted for comment on the new recommendations but declined the opportunity. However, a spokesperson told SBS the AMA maintains its long-held view that antibiotics be prescribed and used carefully and responsibly.

“The AMA supports greater awareness and education for doctors and patients to ensure that antibiotics can continue effectively performing their key role in treating and preventing infections, and keeping Australians healthy,” AMA president, Professor Brian Owler said late last year.

Co-author of the national guidelines, Dr Brendan McMullan from University of NSW, stresses the need for doctors to change current prescribing practices to prevent antimicrobial resistance in children.

“Antibiotic resistance is a growing problem in Australia and worldwide,” says Dr McMullan.

“We need to start using antibiotics better right now, and this study is about using the evidence to promote smarter antibiotic prescribing for children.”

A/Prof Bryant explains that antibiotics themselves aren't the enemy as, in many cases, they are prescribed in hospitals because they are needed and do good. The main target of the guidelines is their overuse.

“From a parent’s point of view, sometimes children need antibiotics and for that reason they are a very precious resource,” she says. “But if we use them for too long then … they might become resistant to them. If that occurs, we are removing that precious resource and few infections will become treatable.

“So this is all about choosing the right situation to use antibiotics and making sure they are used for as short a duration as is safe.”

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