USO RACIONAL DE ANTIBIÓTICOS EN PEDIATRÍA Y EL IMPACTO DE LA RESISTENCIA ANTIMICROBIANA: REVISIÓN INTEGRATIVA BASADA EN EVIDENCIAS RECIENTES
DOI:
https://doi.org/10.56238/levv16n54-016Palabras clave:
Pediatría, Antibióticos, Uso Racional, Resistencia Antimicrobiana, Antimicrobial StewardshipResumen
El uso racional de antibióticos en pediatría representa un desafío creciente, especialmente ante el aumento de la resistencia antimicrobiana y la alta prevalencia de prescripciones inadecuadas en diferentes contextos clínicos. Esta revisión integrativa tuvo como objetivo sintetizar la evidencia publicada entre 2020 y 2025 sobre las intervenciones de Antimicrobial Stewardship (ASP) en niños, analizando su impacto en la prescripción de antimicrobianos y en la resistencia bacteriana. La búsqueda se realizó en bases de datos como PubMed, SciELO, LILACS y BVS, incluyendo revisiones sistemáticas, estudios observacionales y reportes de vigilancia, con un total de diez trabajos seleccionados. Los hallazgos indican que los programas estructurados de ASP, que combinan protocolos clínicos, auditorías diarias, retroalimentación educativa y capacitación continua, promueven el uso racional de antibióticos, reducen las prescripciones empíricas inadecuadas y disminuyen los costos hospitalarios. Estudios en contextos de bajos y medianos ingresos demostraron que intervenciones simples pueden generar resultados clínicos relevantes, aunque los desafíos estructurales y las brechas en la vigilancia microbiológica aún limitan el impacto total de estas estrategias. La resistencia antimicrobiana sigue siendo elevada, especialmente en patógenos como Escherichia coli, Klebsiella spp. y Streptococcus pneumoniae, lo que refuerza la necesidad de políticas públicas integradas, educación profesional continua y medidas preventivas, como la vacunación y la higiene. También se observa una carencia de estudios multicéntricos y longitudinales, así como de datos sobre farmacocinética en diferentes grupos etarios, evidenciando brechas para futuras investigaciones. Se concluye que la adopción de ASP en pediatría es esencial para optimizar la prescripción de antibióticos, mejorar la seguridad clínica y contribuir a la preservación de la eficacia antimicrobiana a largo plazo.
Descargas
Referencias
Abo, Y. N. et al. The impact of antimicrobial stewardship in children in low- and middle-income countries: a systematic review. The Pediatric Infectious Disease Journal, v. 41, n. 3, p. e102-e109, 2022. Disponível em: https://journals.lww.com/pidj/fulltext/2022/03001/the_impact_of_antimicrobial_stewardship_in.3.aspx. Acesso em: 02 out. 2025. DOI: https://doi.org/10.1097/INF.0000000000003317
Akintan, P. et al. Point prevalence surveys of antibiotic prescribing in children in a resource-constrained, low-income country: the impact of an antimicrobial stewardship program. BMC Pediatrics, v. 24, art. 383, 2024. DOI: https://doi.org/10.1186/s12887-024-04847-3
ARIC – Antimicrobial Resistance e Infection Control. Implementation and impact of pediatric antimicrobial stewardship programmes: a systematic scoping review. ARIC Journal, v. 9, n. 3, 2020. Disponível em: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0659-3. Acesso em: 08 out. 2025. DOI: https://doi.org/10.1186/s13756-019-0659-3
Atem, T. D. et al. Prevalence and associated factors of self-medication with antibiotics among pediatric population in India: a systematic review and meta-analysis. BMC Pediatrics, v. 25, p. 451, 2025. Disponível em: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-025-05676-8. Acesso em: 09 out. 2025. DOI: https://doi.org/10.1186/s12887-025-05676-8
Brasil. Ministério da Saúde. Protocolo Nacional de Segurança do Paciente: Uso racional de antimicrobianos. Brasília: MS, 2023.
CDC – Centers For Disease Control And Prevention. Antibiotic Resistance Threats in the United States 2023. Atlanta: CDC, 2023.
Coffin, S. E. et al. Pediatric research priorities in healthcare-associated infections and antimicrobial stewardship. Infectious Disease Clinics of North America, v. 34, n. 2, p. 315-329, 2020. Disponível em: https://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=10993&context=open_access_pubs. Acesso em: 12 out. 2025.
De Barros Fernandes, T.; Ramos, S. F.; Leitzke, L. R. F. et al. Use of antimicrobials in pediatric wards of five Brazilian hospitals. BMC Pediatrics, v. 24, art. 177, 2024. Disponível em: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04655-9. Acesso em: 02 out. 2025. DOI: https://doi.org/10.1186/s12887-024-04655-9
Donà, D. et al. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic review. The Lancet Infectious Diseases, v. 20, n. 2, p. e45-e56, 2020. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31911831/. Acesso em: 20 out. 2025.
Frontiers In Cellular And Infection Microbiology. Editorial: Antimicrobial Resistance In Pediatric infectious diseases: resistance mechanisms and antimicrobial use. Frontiers, 2023. Disponível em: https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1287051/full. Acesso em: 27 out. 2025.
Gerber, J. S.; Hersh, A. L. Antimicrobial stewardship in pediatrics: challenges and opportunities. The Lancet Infectious Diseases, v. 22, n. 11, p. 1534-1545, 2022.
Golli, A. L. et al. Antibiotic resistance pattern of pathogens isolated from pediatric infections: a systematic review. Journal of Clinical Microbiology, v. 62, n. 5, p. e02145-23, 2024. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC11505055/. Acesso em: 27 out. 2025.
Liberati, C. et al. Revisiting antimicrobial stewardship in the paediatric intensive care unit: a study evaluating the effect of guidelines dissemination followed by a handshake approach. The Lancet Infectious Diseases, v. 25, n. 1, p. 45-53, 2025. Disponível em: https://www.sciencedirect.com/science/article/pii/S0195670125000519. Acesso em: 18 out. 2025.
Matoria, R.; Soni, P. Antibiotic resistance a concern in neonatal sepsis cure: study. European Journal of Pediatrics, 2025. Disponível em: https://timesofindia.indiatimes.com/city/jaipur/antibiotic-resistance-a-concern-in-neonatal-sepsis-cure-study/articleshow/122801220.cms. Acesso em: 26 out. 2025.
Michael, J. S. et al. Antimicrobial stewardship in pediatrics: how every pediatrician can be a steward. JAMA Pediatrics, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26582880/. Acesso em: 18 out. 2025.
Newland, J. G.; Banerjee, R.; Gerber, J. S.; Hersh, A. L.; Steinke, L.; Weissman, S. J. Antimicrobial stewardship in pediatric care: strategies and future directions. Pharmacotherapy, v. 32, n. 8, p. 735-743, 2012. DOI: https://doi.org/10.1002/j.1875-9114.2012.01155.x
Scientific Daily. Antibiotics for common childhood infections no longer effective in many parts of the world. ScienceDaily, 31 out. 2023. Disponível em: https://www.sciencedaily.com/releases/2023/10/231031111529.htm. Acesso em: 14 out. 2025.
Silvestro, E. et al. Antimicrobial stewardship in the pediatric emergency department: an observational study. Journal of Antimicrobial Chemotherapy, v. 79, n. 9, p. 2671-2678, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39857877/. Acesso em: 22 out. 2025.
Winteler, C. et al. A systematic review of perinatal antibiotic stewardship. European Journal of Pediatrics, 2025. Disponível em: https://www.nature.com/articles/s41372-025-02209-0. Acesso em: 24 out. 2025.
WHO – World Health Organization. Global action plan on antimicrobial resistance: progress report 2024. Geneva: WHO, 2024.
______. Global antimicrobial resistance and use surveillance system (GLASS) report 2023. Geneva: WHO, 2023. Disponível em: https://www.who.int/publications/i/item/9789240076714. Acesso em: 12 out. 2025.
Zewdie, S. et al. Antibiotic use without prescription among children aged under 5 years in low- and middle-income countries: a systematic review and meta-analysis. BMC Pediatrics, v. 25, p. 451, 2025. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC12142460/. Acesso em: 14 out. 2025. DOI: https://doi.org/10.1093/jacamr/dlaf093
