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The Battle Against Antimicrobial Resistance Time for the Emergency Department to Join the Fight

Rakesh D. Mistry, MD, MS1,2; Peter S. Dayan, MD, MSc3,4; Nathan Kuppermann, MD, MPH5,6
[+] Author Affiliations
1Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora
2Departments of Emergency Medicine and Pediatrics, Children’s Hospital Colorado, Aurora
3Section of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York
4Morgan Stanley Children’s Hospital of New York–Presbyterian, New York
5Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento
6University of California, Davis, Medical Center, Sacramento
JAMA Pediatr. 2015;169(5):421-422. doi:10.1001/jamapediatrics.2015.79.
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This Viewpoint reports on the antimicrobial stewardship programs that have been created in many institutions in response to the overuse of antibiotics that has been implicated as a contributor to childhood morbidities such as asthma and obesity.

Antimicrobial resistance to common bacterial pathogens poses a substantial threat to pediatric public health.1,2 Years of inappropriate and persistent antibiotic overuse, and consequent selective pressure, has led to the evolution of resistant strains of common bacteria that infect children, such as Escherichia coli, Streptococcus pneumonia, and Staphylococcus aureus. Moreover, the overuse of antibiotics has been implicated as a contributor to childhood morbidities such as asthma and obesity. In response, antimicrobial stewardship (AMS) programs have been created in many institutions.3,4 These AMS programs use a collection of strategies, including guidelines, surveillance, education, and evaluation, to optimize antibiotic use.14 The establishment of AMS programs has resulted in measurable positive effects, including improved selection of appropriate antimicrobials, reduction in adverse effects from unnecessary antibiotic exposure, and even local reductions in the prevalence of resistant bacteria.2,3 Importantly, AMS programs produce substantial institutional cost savings, as high as $900 000 annually.3 Consequently, AMS programs are fully established in many children’s hospitals across the United States.4,5

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