Results of a pilot project of microbial therapy management at the children’s hospital

Introduction. In multidisciplinary pediatric hospitals in Russia, the prerequisite for the formation of principles of antimicrobial therapy management as a medical technology, implemented with the participation of a clinical pharmacologist became possible on the basis of updated clinical and pharmacological tools proposed by the World Health Organization (WHO) in 2019.

Purpose. The project goal is to show the possibilities of control of antimicrobial therapy, as a medical technology in multidisciplinary children’s hospitals to improve adherence to domestic clinical recommendations in the actual clinical practice of implementing antibiotic therapy management programs in children on the profile of «Pediatrics».

Material and methods. The pilot scheme was implemented from 2019 to 2021 on the basis of the Morozov Children’s Clinical Hospital by methods of WHO AWaRe and points estimation of prevalence of antibiotic use according to WHO tool checklist in dynamics. Regulatory documents of medical organization (MO) were formed, which ensured transition from traditional to new approaches within 3 years from 2019 to 2021 to maintain clinical practice of antibiotic use based on clinical guidelines.

Results. A comparative study of clinical antibiotic use in children “before” the project in 2019 and “after” in 2021 showed a 2.7-fold decrease in antibiotic use by absolute DDDs from 65.99 in 2019 to 24.34 in 2021. DDDs per 100 p/d. By WHO AWaRe method for absolute values of antibiotics in the “Tolerance” category, a 2-fold decrease in consumption and a 5-fold decrease in consumption for absolute values of antibiotics in the “Control” category: in 2019. — 41.13% (abs. 27.55 PDT per 100 p/d) and in 2021. — 60.1% (abs. 4.64 PDT per 100 p/d). Consumption of “Reserve” category antibiotics by absolute values has not changed.

Limitations. This publication describes one medical institution in which this project was implemented, which somewhat reduces the value of the results obtained.

Conclusion. As a result of the implementation of the principles of managing antimicrobial therapy, this pilot project was able to reduce the irrational use of antibiotics in the pediatric hospital.

Compliance with ethical standards. The study does not require submission of the opinion of the biomedical ethics committee or other documents.

Contribution of the authors:
Vlasova A.V. — research concept and design of the study, collection and processing of material, writing the text;
Smirnova E.V. — statistical data processing, editing;
Volkova N.N. — compilation of a list of references;
Dymnova L.V. — editing, responsibility for the integrity of all parts of the article;
Romanova Yu.V. — collection and processing of material;
Rakhalina A.A. — collection and processing of material;
Sharshakova A.A. — collection and processing of material;
Angel A.E., Gorev V.V., Zhuravleva M.V. — approval of the final version of the article, responsibility for the integrity of all parts of the article.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 2023

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