Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance (2025)

Sheikh, S., Saleem, Z., Afzal, S., Qamar, M. U., Raza, A. A., Naqvi, S. Z. H., Al-Rawi, B. A. (2025). Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance. Frontiers in Pediatrics, 12, 1469766. https://doi.org/10.3389/fped.2024.1469766

Sheikh, Samia ; Saleem, Zikria ; Afzal, Shairyar et al. / Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan : point prevalence surveys using AWaRe guidance. In: Frontiers in Pediatrics. 2025 ; Vol. 12. pp. 1469766.

@article{3ce03312c77e42b1a4b7b8841b2ef93c,

title = "Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance",

abstract = "Introduction: Surveillance of antibiotic use is crucial for identifying targets for antibiotic stewardship programs (ASPs), particularly in pediatric populations within countries like Pakistan, where antimicrobial resistance (AMR) is escalating. This point prevalence survey (PPS) seeks to assess the patterns of antibiotic use in pediatric patients across Punjab, Pakistan, employing the WHO AWaRe classification to pinpoint targets for intervention and encourage rational antibiotic usage.Methods: A PPS was conducted across 23 pediatric wards of 14 hospitals in the Punjab Province of Pakistan using the standardized Global-PPS methodology developed by the University of Antwerp. The study included all pediatric inpatients receiving antibiotics at the time of the survey, categorizing antibiotic prescriptions according to the WHO Anatomical Therapeutic Chemical classification and the AWaRe classification system.Results: Out of 498 pediatric patients, 409 were receiving antibiotics, representing an antibiotic use prevalence of 82.1%. A substantial majority (72.1%) of the prescribed antibiotics fell under the WHO's Watch category, with 25.7% in the Access category and 2.2% in the Reserve group. The predominant diagnoses were respiratory infections, notably pneumonia (32.4%). The most commonly used antibiotics were ceftriaxone (37.2%) and Vancomycin (13.5%). Only 2% of antibiotic uses were supported by culture sensitivity reports, highlighting a reliance on empirical therapy.Conclusion: The high prevalence of antibiotic use, particularly from the Watch category, and low adherence to culture-based prescriptions underscore the critical need for robust antibiotic stewardship programs in Pakistan. Strengthening these programs could help mitigate AMR and optimize antibiotic use, aligning with global health objectives.",

keywords = "pediatric, antimicrobial resistance (AMR), antimicrobial stewardship (AMS), Pakistan, point prevalence survey, WHO AWaRe",

author = "Samia Sheikh and Zikria Saleem and Shairyar Afzal and Qamar, {Muhammad Usman} and Raza, {Ali Abuzar} and Naqvi, {Syed Zeeshan Haider} and Al-Rawi, {Basil A.} and Brian Godman",

note = "This article is part of the Research Topic {"}Pediatric Infectious Diseases and Global Action Plan on AMR{"}",

year = "2025",

month = jan,

day = "10",

doi = "10.3389/fped.2024.1469766",

language = "English",

volume = "12",

pages = "1469766",

}

Sheikh, S, Saleem, Z, Afzal, S, Qamar, MU, Raza, AA, Naqvi, SZH, Al-Rawi, BA 2025, 'Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance', Frontiers in Pediatrics, vol. 12, pp. 1469766. https://doi.org/10.3389/fped.2024.1469766

Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance. / Sheikh, Samia ; Saleem, Zikria ; Afzal, Shairyar et al.
In: Frontiers in Pediatrics, Vol. 12, 10.01.2025, p. 1469766.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan

T2 - point prevalence surveys using AWaRe guidance

AU - Sheikh, Samia

AU - Saleem, Zikria

AU - Afzal, Shairyar

AU - Qamar, Muhammad Usman

AU - Raza, Ali Abuzar

AU - Naqvi, Syed Zeeshan Haider

AU - Al-Rawi, Basil A.

AU - Godman, Brian

N1 - This article is part of the Research Topic "Pediatric Infectious Diseases and Global Action Plan on AMR"

PY - 2025/1/10

Y1 - 2025/1/10

N2 - Introduction: Surveillance of antibiotic use is crucial for identifying targets for antibiotic stewardship programs (ASPs), particularly in pediatric populations within countries like Pakistan, where antimicrobial resistance (AMR) is escalating. This point prevalence survey (PPS) seeks to assess the patterns of antibiotic use in pediatric patients across Punjab, Pakistan, employing the WHO AWaRe classification to pinpoint targets for intervention and encourage rational antibiotic usage.Methods: A PPS was conducted across 23 pediatric wards of 14 hospitals in the Punjab Province of Pakistan using the standardized Global-PPS methodology developed by the University of Antwerp. The study included all pediatric inpatients receiving antibiotics at the time of the survey, categorizing antibiotic prescriptions according to the WHO Anatomical Therapeutic Chemical classification and the AWaRe classification system.Results: Out of 498 pediatric patients, 409 were receiving antibiotics, representing an antibiotic use prevalence of 82.1%. A substantial majority (72.1%) of the prescribed antibiotics fell under the WHO's Watch category, with 25.7% in the Access category and 2.2% in the Reserve group. The predominant diagnoses were respiratory infections, notably pneumonia (32.4%). The most commonly used antibiotics were ceftriaxone (37.2%) and Vancomycin (13.5%). Only 2% of antibiotic uses were supported by culture sensitivity reports, highlighting a reliance on empirical therapy.Conclusion: The high prevalence of antibiotic use, particularly from the Watch category, and low adherence to culture-based prescriptions underscore the critical need for robust antibiotic stewardship programs in Pakistan. Strengthening these programs could help mitigate AMR and optimize antibiotic use, aligning with global health objectives.

AB - Introduction: Surveillance of antibiotic use is crucial for identifying targets for antibiotic stewardship programs (ASPs), particularly in pediatric populations within countries like Pakistan, where antimicrobial resistance (AMR) is escalating. This point prevalence survey (PPS) seeks to assess the patterns of antibiotic use in pediatric patients across Punjab, Pakistan, employing the WHO AWaRe classification to pinpoint targets for intervention and encourage rational antibiotic usage.Methods: A PPS was conducted across 23 pediatric wards of 14 hospitals in the Punjab Province of Pakistan using the standardized Global-PPS methodology developed by the University of Antwerp. The study included all pediatric inpatients receiving antibiotics at the time of the survey, categorizing antibiotic prescriptions according to the WHO Anatomical Therapeutic Chemical classification and the AWaRe classification system.Results: Out of 498 pediatric patients, 409 were receiving antibiotics, representing an antibiotic use prevalence of 82.1%. A substantial majority (72.1%) of the prescribed antibiotics fell under the WHO's Watch category, with 25.7% in the Access category and 2.2% in the Reserve group. The predominant diagnoses were respiratory infections, notably pneumonia (32.4%). The most commonly used antibiotics were ceftriaxone (37.2%) and Vancomycin (13.5%). Only 2% of antibiotic uses were supported by culture sensitivity reports, highlighting a reliance on empirical therapy.Conclusion: The high prevalence of antibiotic use, particularly from the Watch category, and low adherence to culture-based prescriptions underscore the critical need for robust antibiotic stewardship programs in Pakistan. Strengthening these programs could help mitigate AMR and optimize antibiotic use, aligning with global health objectives.

KW - pediatric

KW - antimicrobial resistance (AMR)

KW - antimicrobial stewardship (AMS)

KW - Pakistan

KW - point prevalence survey

KW - WHO AWaRe

U2 - 10.3389/fped.2024.1469766

DO - 10.3389/fped.2024.1469766

M3 - Article

VL - 12

SP - 1469766

JO - Frontiers in Pediatrics

JF - Frontiers in Pediatrics

ER -

Sheikh S, Saleem Z, Afzal S, Qamar MU, Raza AA, Naqvi SZH et al. Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance. Frontiers in Pediatrics. 2025 Jan 10;12:1469766. doi: 10.3389/fped.2024.1469766