PRESCRIBING PATTERNS AND RATIONAL USE OF ANTIBIOTICS AND CORTICOSTEROIDS IN PEDIATRIC POPULATIONS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.66104/gwrdsg21Keywords:
Antibiotics; Corticosteroids; Pediatrics; Rational use of medicines; Antimicrobial stewardship.Abstract
Antibiotics and corticosteroids are among the most frequently prescribed medications in pediatric populations and are widely used in the treatment of infectious and inflammatory conditions. However, inappropriate use of these pharmacological classes is associated with significant adverse outcomes, including antimicrobial resistance, immunosuppression, and increased healthcare costs. Despite the availability of clinical guidelines, substantial variability persists in prescribing practices, particularly regarding empirical use and adherence to institutional protocols. This study aimed to evaluate prescribing patterns and the degree of rational use of antibiotics and corticosteroids in children, identifying appropriate and inappropriate practices reported in recent literature. This systematic review was registered in PROSPERO (CRD420251045497) and conducted in accordance with PRISMA guidelines. Searches were performed in the SciELO, PubMed, and Virtual Health Library (VHL) databases, including studies published between 2019 and 2025, available in English and in full text. Clinical trials and observational studies addressing prescribing patterns and rational drug use in pediatrics were included. Thirteen studies met the eligibility criteria. A high prevalence of empirical antimicrobial prescribing was observed, with frequent use of broad-spectrum antibiotics and variable adherence to clinical guidelines. Regarding corticosteroids, benefits were limited to specific clinical conditions, and indiscriminate use was not supported by evidence. Persistent challenges in therapeutic rationality were identified, highlighting the need to strengthen antimicrobial stewardship programs, clinical protocols, and continuous educational strategies to promote safe and evidence-based prescribing practices in pediatric care.
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BARROS FERNANDES, T. et al. Use of antimicrobials in pediatric wards of five Brazilian hospitals. BMC Pediatrics, v. 24, p. 177, 2024. DOI: https://doi.org/10.1186/s12887-024-04655-9. DOI: https://doi.org/10.1186/s12887-024-04655-9
COUTO, D. S. et al. Survey on timely administration of antimicrobials and antimicrobial management programs: nursing role. Revista de Enfermagem do Centro-Oeste Mineiro, v. 14, e5096, 2024.
DEL FIOL, F. S. et al. Patterns of antibiotic consumption in children in Brazil: a retrospective analysis of sales between 2014 and 2021. Antibiotics, v. 11, n. 4, p. 446, 2022. DOI: https://doi.org/10.3390/antibiotics11040446. DOI: https://doi.org/10.3390/antibiotics11040446
FARIAS-FILHO, F. A. et al. Multiple-step antimicrobial stewardship approach in a neonatal intensive care unit: a quasi-experimental study. Revista de Epidemiologia e Controle de Infecção, v. 14, n. 3, p. 382–388, 2024.
FENNER, A. et al. Antibiotic exposure of critically ill children at a tertiary care paediatric intensive care unit in Switzerland. Children, v. 11, n. 6, p. 731, 2024. DOI: https://doi.org/10.3390/children11060731. DOI: https://doi.org/10.3390/children11060731
GILL, P. J. et al. Association between corticosteroids and outcomes in children hospitalized with orbital cellulitis. Hospital Pediatrics, v. 12, n. 1, p. 70–89, 2022. DOI: https://doi.org/10.1542/hpeds.2021-005910. DOI: https://doi.org/10.1542/hpeds.2021-005910
GUPTA, R. et al. Corticosteroid therapy in children: balancing benefits and risks. Journal of Pediatric Pharmacology and Therapeutics, v. 26, n. 2, p. 134–141, 2021. DOI: https://doi.org/10.5863/1551-6776-26.2.134.
HALLS, A. et al. Interventions to improve antibiotic prescribing practices in pediatric primary care: a systematic review. BMJ Open, v. 10, e039137, 2020. DOI: https://doi.org/10.1136/bmjopen-2020-039137.
INUMARU, F. E. et al. Profile and appropriate use of antibiotics among children in a general hospital in Southern Brazil. Revista Paulista de Pediatria, v. 37, n. 1, p. 27–33, 2019. DOI: https://doi.org/10.1590/1984-0462/2019;37;1;00011.
LEVY-HARA, G. et al. Point prevalence survey of antibiotic use in hospitals in Latin American countries. Journal of Antimicrobial Chemotherapy, v. 77, n. 3, p. 807–815, 2022. DOI: https://doi.org/10.1093/jac/dkab459. DOI: https://doi.org/10.1093/jac/dkac120
LE THI, T. V.; PHAM, E. C.; DANG-NGUYEN, D. T. Evaluation of children’s antibiotics use for outpatient pneumonia treatment in Vietnam. Brazilian Journal of Infectious Diseases, v. 28, n. 4, 103839, 2024. DOI: https://doi.org/10.1016/j.bjid.2024.103839. DOI: https://doi.org/10.1016/j.bjid.2024.103839
MANGIONE-SMITH, R. et al. Parental expectations and antibiotic prescribing for children. Pediatrics, v. 145, n. 6, e20193750, 2020. DOI: https://doi.org/10.1542/peds.2019-3750. DOI: https://doi.org/10.1542/peds.2019-3750
NAMDARIFAR, F. et al. Drug utilization study in neonatal intensive care unit at tertiary care hospital. Revista da Associação Médica Brasileira, v. 68, n. 4, p. 445–451, 2022. DOI: https://doi.org/10.1590/1806-9282.20211040. DOI: https://doi.org/10.1590/1806-9282.20210831
NASSO, C. et al. Appropriateness of antibiotic prescribing in hospitalized children: a focus on the real-world scenario of the different paediatric subspecialties. Frontiers in Pharmacology, v. 13, 890398, 2022. DOI: https://doi.org/10.3389/fphar.2022.890398. DOI: https://doi.org/10.3389/fphar.2022.890398
NORERO, X. et al. Point prevalence survey of antibiotics in a pediatric tertiary hospital in the Republic of Panama. Revista Panamericana de Salud Pública, v. 49, e7, 2025. DOI: https://doi.org/10.26633/RPSP.2025.7. DOI: https://doi.org/10.26633/RPSP.2025.7
PICCA, M. et al. Leading reasons for antibiotic prescriptions in pediatric respiratory infections: influence of fever in a primary care setting. Italian Journal of Pediatrics, v. 49, n. 1, p. 131, 2023. DOI: https://doi.org/10.1186/s13052-023-01533-5. DOI: https://doi.org/10.1186/s13052-023-01533-5
TCHERVENKOV, J. I. et al. Optimizing antibiotic use in pediatric populations: antimicrobial stewardship and beyond. Pediatric Infectious Disease Journal, v. 40, n. 4, p. e153–e157, 2021.
WALD, E. R.; EICKHOFF, J. C. Impact of steroids as adjuvant therapy in acute bacterial infections of childhood. Pediatrics, v. 148, n. 5, e2021053062, 2021. DOI: https://doi.org/10.1542/peds.2021-053062. DOI: https://doi.org/10.1542/peds.2021-053062
WORLD HEALTH ORGANIZATION. WHO report on surveillance of antibiotic consumption: 2016–2018 early implementation. Geneva: WHO, 2018.
YANG, E.-A. et al. Early corticosteroid therapy for Mycoplasma pneumoniae pneumonia irrespective of used antibiotics in children. Journal of Clinical Medicine, v. 8, n. 5, p. 726, 2019. DOI: https://doi.org/10.3390/jcm8050726. DOI: https://doi.org/10.3390/jcm8050726
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Copyright (c) 2026 Juliano Kyt Moreira , Jéssica Emanuele de Oliveira, Katherin Crispim Morais Machado , Marcelo Dias de Azevedo Júnior , Natália Maria Dias Pereira , Vanessa Emanuelle dos Reis Milani, Anna Luiza Pires Vieira

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