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22 ANTIBIOTIC RESISTANCE & STEWARDSHIP Amoxicillin prescription rates low for children's infections, study finds By Harrison Cook R esearchers at the St. George's Univer- sity of London ran a global compar- ison of antibiotic use and found few physicians prescribe amoxicillin to treat common childhood infections and instead use antibiotics for specific infections, ac- cording to a study published in e Lancet Infectious Diseases. Four things to know: 1. For the study, researchers analyzed whole antibiotic sales in 70 high- and middle- income countries in 2015. Researchers identified the antibiotics young children took by using the IQVIA-Multinational Integrated Data Analysis System database. ey estimated antibiotic use by using the 2017 World Health Organization Essential Medicines List's Access, Watch, Reserve antibiotic groups. 2. In 2017, the WHO divided antibiotics into three categories: access, watch and reserve. ese categories help ensure physi- cians prescribe the right antibiotics for the right infections. 3. Researchers found the watch category, or antibiotics used for a specific infection, made up 20 percent of the total antibiotic consumption. ere is a higher risk of bacteria developing resistance to antibiotics in the watch category. 4. e report indicated use of access anti- biotics on average made up 76 percent of child-appropriate antibiotic prescriptions in all countries. Amoxicillin use was low, mak- ing up 31 percent. e WHO said amoxi- cillin, an access antibiotic, should be used first, before other antibiotic treatments. "is is the first attempt at developing sim- ple metrics of global child community an- tibiotic use based on the WHO's grouping. e data can be used by countries to assess their antibiotic use patterns for young chil- dren. Countries with low access percentages can identify opportunities for greater use of these antibiotics. Unnecessary use of watch antibiotics is more clearly identifiable," said Julia Bielicki, MD, senior lecturer at St. George's University of London. n Does antibiotic treatment duration matter for hospitalized patients with Gram-negative bacteremia? By Anuja Vaidya A study published in Clinical Infectious Diseases exam- ined the duration of antibiotic treatment for hospital- ized patients with Gram-negative bacteremia. Researchers conducted a randomized, multicenter, non-in- feriority trial involving patients with Gram-negative bactere- mia. They included 604 patients from three centers in Israel and Italy, of which 306 received seven days of antibiotic therapy and 298 received 14 days of antibiotic therapy. They set the non-inferiority margin at 10 percent. The study was conducted between January 2013 and August 2017. The primary outcome at 90 days was a composite of all- cause mortality; relapse, suppurative or distant complica- tions; and re-admission or extended hospitalization less than 14 days. The primary outcome occurred in 45.8 percent of patients in the seven-day group and in 28.3 percent of patients in the 14-day group. Researchers observed no significant differ- ences in all other outcomes and adverse events. "Reducing antibiotic treatment for uncomplicated Gram-neg- ative bacteremia to seven days is an important antibiotic stewardship intervention," the study authors concluded. n Non-children's hospitals fall short when treating kids for pneumonia, study finds By Harrison Cook R esearchers performed a retrospective analysis to investigate how hospitals adhere to the national guidelines for community-acquired pneumonia and found only 27 percent of pediatric patients were prescribed the recommended antibiotics at non-chil- dren's hospitals, according to a study published in JAMA Pediatrics. For the study, researchers used two hospital billing databases for inpatient discharges from across the U.S. They included children from ages 1 to 17 admitted to the hospital for pneumonia between Jan. 1, 2009, and Sept. 30, 2015. Researchers also looked for patients discharged from children's hospitals and non-children's hospitals. Researchers found 120,238 children with pneumonia were discharged from 51 children's hospitals, and 65,209 were discharged from 471 non-children's hospi- tals. Four years after the national pediatric pneumonia guidelines were published, only 27 percent of children admitted to non-children's hospitals received therapy according to national guidelines, compared to the 61 percent who received guideline-compliant treatment in children's hospitals. National guidelines recommend penicillin, amoxicillin and ampicillin as first-line treat- ments for children hospitalized with pneumonia. n