RATIONAL USE OF ANTIBIOTICS IN PEDIATRICS AND THE IMPACT OF ANTIMICROBIAL RESISTANCE: INTEGRATIVE REVIEW BASED ON RECENT EVIDENCE

Abstract

The rational use of antibiotics in pediatrics is an increasing challenge, especially given the rise in antimicrobial resistance and the high prevalence of inappropriate prescriptions in different clinical contexts. This integrative review aimed to synthesize evidence published between 2020 and 2025 on Antimicrobial Stewardship (ASP) interventions in children, analyzing their impact on antimicrobial prescription and bacterial resistance. The search was conducted in databases such as PubMed, SciELO, LILACS, and BVS, including systematic reviews, observational studies, and surveillance reports, totaling ten selected papers. The findings indicate that structured ASP programs combining clinical protocols, daily auditing, educational feedback, and continuous training promote rational antibiotic use, reduce inappropriate empirical prescriptions, and lower hospital costs. Studies conducted in low- and middle-income settings demonstrated that simple interventions can produce significant clinical results, although structural challenges and gaps in microbiological surveillance still limit the full impact of these strategies. Antimicrobial resistance remains high, particularly among pathogens such as Escherichia coli, Klebsiella spp., and Streptococcus pneumoniae, reinforcing the need for integrated public policies, continuous professional education, and preventive measures such as vaccination and hygiene. There is also a shortage of multicenter and longitudinal studies, as well as data on pharmacokinetics across different age groups, highlighting gaps for future research. It is concluded that the implementation of ASP in pediatrics is essential to optimize antibiotic prescription, improve clinical safety, and help preserve antimicrobial efficacy in the long term.