WHO AWaRe Method for Analysis of Clinical Practice of Antimicrobial Therapy in Children's Multidisciplinary Hospitals in Russia

Abstract

The new AWaRe classification proposed by WHO for assessing the clinical practice of using antibiotics in adults in 2017 was adapted for children's hospitals in 2019, due to the update of the categorization of antimicrobials, and showed effec- tiveness for assessing the rationality of antimicrobials use in children's hospitals in WHO-participating countries in the observation protocol GARPEC. In this retrospective pharmacoepidemiological study, we assessed the rationality of antibiotic consumption in multidisciplinary hospitals in the subjects of the Russian Federation with a pediatric profile. An observational multicenter study of antibiotic consumption was carried out in the constituent entities of the Russian Federation (N=9). Consumption assessment was carried out using the AWaRe method, based on DDD analysis and the WHO list of essential antibiotics for children by groups: «Access» (green), «Watch» (yellow) and «Reserve»(red). The quantitative indicator «the number of days of therapy in the ATC group J01 Antibacterial drugs for systemic use» in the established standardized dose per 100 patient days in the pediatric profile in level III hospitals in 9 regions of Russia for 2021 was 214.93. On average, each of the hospitalized pediatric children received at least two antibiotics during the period of hospital treatment in 2021 in Russia. On average, in Russia, based on the results from 9 constituent entities of the Russian Federation, drugs in the «Admission» category were 44.24%, «Control» — 49.23%, «Reserve» — 0.88%. When categorizing according to WHO2019, negative characteristics were identified — either excessive use of cefazolin and amikacin in the «Access» category, or the predominance of drugs with antipseudomonas activity, ceftazidime and cefepime, in the «Watch» groups. A positive and more balanced version of the structure of antibiotic consumption in multidisciplinary children's hospitals was identified in Moscow («Access» — 37.3%, «Watch» — 59.29%, «Reserve» — 3.41%), in the Republic of Mari El («Access» — 30.28%, «Watch» — 69.42%, «Reserve» — 0.30%) and in the Republic of Khakassia («Access» — 30.95%, «Watch» — 67.39%, «Reserve» — 1.66%). Thus, «Access» (green), the main indicator of the assessment category of antibiotic consumption in children, did not reach 60% in 2021 in any of the multidisciplinary children's hospitals in Russia presented in this study, which was proposed as a target indicator for achieving rational consumption according to WHO. The results of this study showed the problems of irrational use of antibiotics: insufficient use of oral dosage forms in children, excessive use of aminoglycosides, unjustified switching to combination antimicrobial therapy with antibiotics of the «Reserve» group in multidisciplinary children's hospitals in Russia.

Keywords

• pediatrics
• antibiotics
• antibiotic consumption in hospital
• aware classification