@article{01GV61PBXCYYXH5VDH3GZEZW8C,
  abstract     = {{Background Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions.

Methods 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications.

Findings Of the 23 572 patients included from 56 countries, 18305 were children (77.7%) and 5267 were neonates (22.3%). Access antibiotic use in children ranged from 7.8% (China) to 61.2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77.3%) and lowest in Finland (23.0%). In neonates, Access antibiotic use was highest in Singapore (100.0%) and lowest in China (24.2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries.

Interpretation There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.}},
  author       = {{Hsia, Yingfen and Lee, Brian R and Versporten, Ann and Yang, Yonghong and Bielicki, Julia and Jackson, Charlotte and Newland, Jason and Goossens, Herman and Magrini, Nicola and Sharland, Mike and Irwin, Adam and Akula, Akhila and Bamford, Alasdair and Chang, Amanda and da Silva, Andre and Whitelaw, Andrew and Dramowski, Angela and Vasudevan, Anil Kumar and Sharma, Anita and Justicia, Antonio and Chikkappa, Ashok and Slowinska-Jarzabek, Barbara and Rippberger, Bianca and Zhao, Changan and Tersigni, Chiara and Cheng, Chinglan and Harkensee, Christian and Jing, Chuamei and Zhu, Chunmei and Li, Chunyan and Tagliabue, Claudia and Epalza, Cristina and Jacqueline, Daglish and Tian, Daiyin and Jinka, Dasaratha and Gkentzi, Despoina and Dharmapalan, Dhanya and Benadof, Dona and Papadimitriou, Eleni and Iosifidis, Elias and Roilides, Emmanuel and Yarci, Erbu and Majda-Stanisławska, Ewa and Gowin, Ewelina and Chappell, Faye and Torres, Federico Martinon and Collett-White, Francis and Liu, Gang and Lu, Gen and Syrogiannopoulos, George and Pitsava, Georgia and Alvarez-Uria, Gerardo and Renk, Hana and Mahmood, Hana and Saxen, Harri and Finlayson, Heather and Green, Helen and Rabie, Helena and Kandraju, Hemasree and Zhang, Hong and Okokon, Ita and Cross, Jack and Herberg, Jethro and Li, Jianping and Zhang, Jiaosheng and Deng, Jikui and Liu, Jing and Qian, Jing and Yang, Jinhong and Sicińska, Joanna and Hübner, Johannes and Fukuoka, Kahoru and Yao, Kaihu and Cheung, Kaman and Ojeda, Karla and Kaffe, Katerina and Kreitmeyer, Katharina and Doerholt, Katja and Grimwood, Keith and Ledoare, Kirsty and Vazouras, Konstantinos and Shen, Kunling and Tang, Lanfang and Zhang, Lehai and Lin, Li and Ashkenazi-Hoffnung, Liat and Wu, Lijuan and Wang, Lijun and Teston, Lilian and Galli, Luisa and Speirs, Lynne and Tsolia, Maria and Hufnagel, Markus and Knuf, Markus and Duse, Marzia and Ding, Mingjie and Rozic, Mojca and Premru, Mueller and O'Connell, Natasha and Rieber, Nikolaus and Spyridis, Nikos and Tunga, Onkaraiah and Conejo, Pablo Rojo and McMaster, Paddy and Lumbiganon, Pagakrong and Pansa, Paola and D'Argenio, Patrizia and Moriarty, Paul and Nikolic, Petra and Wang, Ping and Paopongsawan, Pongsatorn and Cao, Qing and Deng, Qiulian and Laxminarayan, Ramanan and Kanithi, Ravishankar and Jimenez, Rodolfo and Cao, Sancheng and Singh, Sanjeev and Rees, Sarah and Praveen, Saroey and Kekomaki, Satu and Hackett, Scott and Ashkenazi, Shai and Chang, Si Min and Drysdale, Simon and Koning, Sonia and Subramanian, Sreeram and Murki, Srinivas and Vergnano, Stefania and Gandra, Sumanth and Esposito, Susanna and Anugulruengkitt, Suvaporn and Puthanakit, Thanyawee and Behrends, Uta and Papaevangelous, Vana and Jian, Victoria and Li, Wei and Zhao, Wei and Wang, Wei and Zhang, Wenshuang and Mu, Xiaoping and Dong, Xiaoyie and Jiang, Xiyuan and Chen, Xu and Wang, Yi and Zheng, Yuejie and Horikoshi, Yuho and Aboderin, Aaron and Olayinka, Adebola and Dedeic-Ljubovic, Amela and McCorry, Ann and Enimil, Anthony and Neubert, Antje and solano, antonio and Pignatari, Antonio and Poojary, Aruna and Kambaralieva, Baktygul and McCullagh, Bernadette and Carevi, Biljana and Van Herendael, Bruno and Gormley, Cairine and Carvajal, Camila and Ramírez, Carlos and Fitzgerald, David and Sabuda, Deana and Konopnicki, Deborah and Lacej, Denada and Pierard, Denis and Rios, Edgar and Marshall, Emily and Firre, Eric and van Elzakker, Erika and Shaqiri, Erjona and Darwish Elhajji, Feras and Gawrys, Gerard and Markovic, Goran and Kunsihima, Hiroyuki and Chen, Hui Hiong and Sviestina, Inese and Pristas, Irina and Hoxha, Iris and Korinteli, Irma and Mareković, Ivana and Soltani, Jafar and Labarca, Jaime and AlSalman, Jameela and Horvatic, Jasminka and Frimpong, Juliet Ampomah and Pagava, Karaman and Kei, Kasahara and Okinaka, Keiji and Iregbu, Kenneth and Ghazaryan, Lilit and Raka, Lul and Gessner-Wharton, Mallory and Aldeyab, Mamoon and Cooper, Mandelin and del Castillo, Marcelo and Hojman, Martin and Hudson, Melissa and Alshehri, Mohamed and Ling, Moi Lin and Greer, Nickie and Oduyebo, Oyinlola and Buijtels, Patricia and TEROL BARRERO, PEDRO and Zarb, Peter and Schelstraete, Petra and Nwajiobi-Princewill, Princewill Ifeanyi Philip and Khanna, Priya and Quiros, Rodolfo and Simovic, Sanja and Thompson, Sarah and Chan, Si Min and Burokiene, Sigita and Drysdale, Simon and Rachina, Svetlana and Usonis, Vytautas and Cornistein, Wanda and Holemans, Xavier and Gu, Yoshiaki and Brothers, Adam and Hersh, Adam and Fernandez, Alfred and Tribble, Alison and Hurst, Amanda and Green, Andrea and Hammer, Benjamin and Lee, Betty P and Kuzmic, Brenik and Shapiro, Craig and Boge, Craig and Haslam, David and Berman, David and Naeem, Fouzia and Johnson, George and Schwenk, Hayden and Orr, Hillary and Maples, Holly and Olsen, Jared and Gerber, Jeffrey and Girotto, Jennifer and Zweiner, Jennifer and Goldman, Jennifer and Gillon, Jessica and Tansmore, Jessica and Manaloor, John and Courter, Joshua and Mongkolrattanothai, Kanokporn and Patel, Karisma and Merkel, Kathryn and Namtu, Katie and Flett, Kelly and Lee, Kelly and Nichols, Kristen and Klein, Kristin and Handy, Lori and Castagnini, Luis and Mazade, Marc and Heger, Margaret and Fernandez, Marisol and Chang, Michael and Crawford, Michelle and Nelson, Miranda and Bennett, Nicholas and Jaggi, Preeti and Hamdy, Rana and Banerjee, Ritu and Olivero, Rosemary and Patel, Sameer and Arnold, Sandra and Ogrin, Sara and Jones, Sarah and Parker, Sarah and Kubes, Sarah and Hymes, Saul and Weissman, Scott and Chan, Shannon and Henderson, Sheryl and Metjian, Talene and GARPEC and Global-PPS networks, on behalf of the}},
  issn         = {{2214-109X}},
  journal      = {{LANCET GLOBAL HEALTH}},
  keywords     = {{General Medicine,POINT PREVALENCE SURVEY,QUALITY INDICATORS,SURVEILLANCE,STEWARDSHIP,CHILDREN}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{e861--e871}},
  title        = {{Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe) : an analysis of paediatric survey data from 56 countries}},
  url          = {{http://doi.org/10.1016/s2214-109x(19)30071-3}},
  volume       = {{7}},
  year         = {{2019}},
}

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