Pediatric antimicrobial stewardship in the COVID-19 outbreak

To the Editor—Growing evidence supports the positive impact of antimicrobial stewardship programs (ASPs) on antimicrobial use, including pediatrics.1 Although short of the level of acceptance these have reached in the United States, the implementation of pediatric ASPs in European hospitals has increased over the last few years.1 It has been suggested that the ASP should be helpful in the preparation for and response to the SARS-CoV-2/COVID-19 outbreak,2 but no formal recommendations have been published. From March 16 to April 30 2020, 210 randomly selected prescriptions were assessed for quality.3 Because SARS-CoV-2 is a viral infection, it is not expected to directly influence antibiotic or antifungal use beyond the use of antibiotics with possible antiviral effect (ie, azithromycin)4 and the use of broad-spectrum antibiotics for superinfection in severe COVID-19 patients.5 However, we also observed antimicrobial use changes indirectly related to the outbreak. New COVID-19 protocols are constantly updated in accordance with newly available information, and previous protocols have been temporarily modified in favor of medical nonsurgical management of some conditions (eg, noncomplicated appendicitis).7 Our data show that the SARS-CoV-2 pandemic has the potential to have a significant impact on antimicrobial use in the pediatric inpatient population; pediatric ASP monitoring and interventions remain useful to preserve the quality of prescriptions, at least in the short term. Planning the response to epidemic waves should include the widespread integration of ASP, with (1) involvement of the ASP team in guidelines development as exemplified in “Multicenter Initial Guidance on Use of Antivirals for Children with COVID-19/SARS-CoV-2”8; (2) integrated response of common ASP local and external partnerships and infrastructures, including structured interviews, formularies, and other information technology tools9; and (3) coordination of indicator selection and monitoring routines to support a continuous evaluation strategy.