INDISCRIMINATE USE OF ANTIBIOTICS IN PEDIATRICS AND ITS IMPACT ON BACTERIAL RESISTANCE: A NARRATIVE REVIEW

Resumo

Introduction: Antibiotics are among the most significant advances in modern medicine; however, their indiscriminate use has driven a global increase in antimicrobial resistance (AMR). In pediatrics, this issue is particularly critical in children with chronic disea ses, such as cancer, diabetes, and obesity, who require frequent antimicrobial therapy due to immunosuppression, recurrent infections, and prolonged hospitalizations, making them especially vulnerable to multidrug-resistant organisms. Objective: To review the scientific literature on inappropriate antibiotic use in pediatrics, with emphasis on patients with chronic diseases, its relationship with bacterial resistance, and available prevention strategies. Methods: Narrative literature review conducted in Pub Med, SciELO, and LILACS databases (2013 -2025), using DeCS/MeSH descriptors: Anti - Bacterial Agents, Pediatrics, Drug Resistance, Bacterial, Chronic Disease, Neoplasms, Diabetes Mellitus, Obesity, and Antimicrobial Stewardship, combined with Boolean operators (AND/OR). Inclusion criteria: original articles, reviews, and guidelines in Portuguese, English, or Spanish addressing antibiotic use in pediatric populations with chronic diseases, with full text available. Exclusion criteria: studies restricted to adults, duplicates, unavailable full texts, and non-empirical opinion pieces. Of 38 studies identified, 24 met inclusion criteria. Limitation: as a narrative review, results depend on the methodological quality and availability of included studies. Results: Between 20% and 50% of antibiotic prescriptions in pediatrics are inappropriate, predominantly in viral respiratory infections. Among children with cancer, type 1 diabetes, or obesity-related comorbidities, antibiotic exposure is significantly more frequent and prolonged, amplifying selective bacterial pressure. This contributes to the emergence of MRSA, MDR Gram- negative bacteria, and ESKAPE pathogens, increasing morbidity, mortality, hospital length of stay, and healthcare costs. Antimicrobial Stewardship Programs (ASP), AWaRe classification, and 48 - hour therapeutic reassessment have demonstrated positive outcomes in this population. Conclusion: Inappropriate antibiotic use in children with chronic diseases accelerates resistance and worsens clinical outco mes. Evidence -based protocols and multidisciplinary education are essential to promote rational antimicrobial use and protect this vulnerable population. REFERENCES: 1. BROOM, Alex et al. Antimicrobial stewardship in pediatric care: a systematic review. Pediatrics, Elk Grove Village, v. 135, n. 5, p. 826 -833, 2015. 2. DELLIT, Timothy H. et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases, Oxford, v. 44, n. 2, p. 159 -177, 2007. 3. GERBER, Jeffrey S. et al. Antibiotic exposure during the first 6 months of life and weight gain during childhood. JAMA, Chicago, v. 315, n. 12, p. 1258 -1265, 2016. 4. HERSH, Adam L. et al. Frequency of first -line antibiotic selection among US ambulatory care visits for otitis media, sinusitis, and pharyngitis. JAMA Internal Medicine, Chicago, v. 176, n. 12, p. 1870 -1872, 2016. 5. LAXMINARAYAN, Ramanan et al. Antibiotic resistance-the need for global solutions. The Lancet Infectious Diseases, London, v. 13, n. 12, p. 1057 -1098, 2013. 6. O’NEILL, Jim. Tackling drug -resistant infections globally: final report and recommendations. London: Review on Antimicrobial Resistance, 2016. 7. SOCIEDADE BRASILEIRA DE PEDIATRIA (SBP). Uso racional de antimicrobianos em pediatria. Rio de Janeiro: SBP, 2022. 8. TAMMA, Pranita D.; COSGROVE, Sara E. Antimicrobial stewardship. Infectious Disease Clinics of North America, Philadelphia, v. 25, n. 1, p. 245 -260, 2011. 9. VENTOLA, C. Lee. The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and Therapeutics, Philadelphia, v. 40, n. 4, p. 277 -283, 2015. 10. WORLD HEALTH ORGANIZATION (WHO). WHO AWaRe (Access, Watch, Reserve) classi fication of antibiotics for evaluation and monitoring of use. Geneva: WHO, 2023. Available at: WHO AWaRe Classification. Accessed on: May 5, 2026. 11. WORLD HEALTH ORGANIZATION (WHO). Antimicrobial resistance. Geneva: WHO, 2023. Available at: WHO - Antimicrobial Resistance. Accessed on: May 5, 2026.