Ejaz A Khan.
A Review of Antimicrobial Resistance for Common Pediatric Infections in Pakistan -Time for Pediatricians to Do More!.
Infect Dis J Jan ;22(4):613-27.

Background: Antimicrobial resistance to old and new antibiotics has alarmingly increased worldwide including Pakistan. This trend has been documented in health care facilities, particularly in high-risk areas such as intensive care units, surgical units and neonatal intensive care units, over the last few decades. Children of all ages, including neonates, have been equally affected. The treatment of several pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), penicillin-resistant Streptococcus pneumoniae and vancomycin-resistant enterococci (VRE), resistant tuberculosis, malaria is problematic. In this article we review the available pediatric data available on antibiotic resistance in Pakistan. Materials and Methods: Articles from both international and local literature were selected using search words “pediatric infections”, “antibiotic resistance”, “culture and susceptibility” and “children” in PUBMED and PakMedinet. All articles up till 2008 were included. Results: In Pakistan nearly all neonatal and childhood infections have consistently shown a rise in resistance to both traditional and alternative antimicrobials. Pathogens causing neonatal infections have resistance rates of more than 50%. Diarrheal pathogens such as shigella and cholera are resistant to first line agents and even second line agents. Typhoid has considerable resistance to first line drugs with rising resistance to quinolones and third generation cephalosporins. The common respiratory pathogens Haemophilus (H) influenzae), Moraxella (M) catarrhalis and Streptococcus (Strep) pneumoniae in few studies have documented resistance in 10-70%. MRSA is up to 30% of Staphylococcus isolates. Malaria resistance is up to 35%. In tuberculosis (TB) resistance (~50%) and MDR TB (>2%) has also emerged as a major threat in the control of TB. Data for other common infections such as urinary tract infections and skin and soft tissue infections have also shown similar trends. The presence of these resistant organisms translates into a high morbidity and mortality besides significant economic burden. Various factors have contributed to this including indiscriminate misuse of antibiotics, nonexistent infection control policies, nonexistent microbiologic facilities and research. The inappropriate use of antibiotics remains a common and well-recognized practice. It is estimated that at least 20-50% of antibiotics are unnecessarily prescribed. Conclusion: The inappropriate use of antibiotics remains a common and well-recognized practice. The presence of these resistant organisms translates into a high morbidity and mortality besides significant economic burden One practical solution is the judicious use of antibiotics by all clinicians. All stakeholders should be mobilized including physicians, infectious disease specialists, nurses, hospital administration and government for this noble purpose.

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