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Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK
  1. Myriam Gharbi1,
  2. Katja Doerholt2,
  3. Stefania Vergnano3,
  4. Julia Anna Bielicki3,
  5. Stéphane Paulus4,
  6. Esse Menson5,
  7. Andrew Riordan4,
  8. Hermione Lyall6,
  9. Sanjay Valabh Patel7,
  10. Jolanta Bernatoniene8,
  11. Ann Versporten9,
  12. Maggie Heginbothom10,
  13. Herman Goossens9,
  14. Mike Sharland2,3
  15. for the ARPEC project Group members
  1. 1NIHR Health Protection Research Unit Antimicrobial Resistance and Healthcare Associated Infection—Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK
  3. 3Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
  4. 4Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  5. 5Department of General Paediatrics, Evelina London Children's Hospital, London, UK
  6. 6Department of Infectious Diseases, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK
  7. 7Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
  8. 8Paediatric Infectious Disease and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Bristol, UK
  9. 9Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium
  10. 10National Public Health Service for Wales, Cardiff, UK
  1. Correspondence to Dr Myriam Gharbi; m.gharbi{at}


Background The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance.

Methods We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates.

Results A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam.

Conclusions We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.

  • Antimicrobials resistance
  • Paediatric practice
  • Surveillance
  • Quality indicators
  • Benchmarking

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors MG, KD, JAB, AV, HG and MS had substantial contributions to the conception and the design of the work; MG, KD, SV, JAB, SP, EM, AR, HL, SVP, JB, AV, MH, HG and MS participated in the acquisition and interpretation of data for the work. The data management was carried out by AV and MG and the data analysis by MG. MG, KD, SV and MS drafted the work and MG, KD, SV, JAB, SP, EM, AR, HL, SVP, JB, AV, MH, HG and MS revised it critically for important intellectual content; all authors gave the final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The ARPEC project was co-funded by the European Commission Directorate General for Health and Consumers (DG SANCO) through the Executive Agency for Health and Consumers (agreement number—20091101; The October to November 2012 ARPEC-PPS was co-funded by PENTA ( MG is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infection/Antimicrobial Resistance and the NIHR Imperial Biomedical Research Centre (BRC) at Imperial College London in partnership with Public Health England (PHE).

  • Disclaimer The views expressed are those of the author(s) and are not necessarily those of the National Health Service (NHS), the NIHR, the Department of Health or PHE.

  • Competing interests None declared.

  • Ethics approval UK Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The additional unpublished data on antimicrobial prescribing for neonates and children are currently being published within the ARPEC project.

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