The safety of medicinal prescriptions in children in critical conditions: antibiotics are in focus

Introduction. The relevance of the introduction of a system for evaluating medicinal prescriptions to control the safety of the use of antibiotics and concomitant therapy is due to the emergence of electronic medical records in multidisciplinary children’s hospitals. Aim. To assess the potential risks of adverse reactions to antibiotics using an implemented retrospective cohort analysis of antimicrobial drug prescriptions in critically ill children. Materials and methods. The analysis of the effect of antibiotic prescriptions on the potential risk of HP in the development of a critical condition in children was performed as part of a prospective observational study at the Morozov Children’s City Clinical Hospital from 02/01/2020 to 09/01/2021 in 100 children aged 0 to 17 years. To evaluate the prescribing lists, a twostage retrospective cohort analysis method was used to assess the potential risks of HP for antibiotics in the development of a critical condition in children with nosocomial infection. The patients were divided into 2 cohorts in 2 stages: at stage 1, an analysis was performed in 1 cohort “outcome HP+” of 30 children with HP on antibiotics and 2 cohort “outcome HP–” of 70 children without HP on antibiotics. At stage 2, an analysis was carried out in the same cohorts with an additional sampling criterion “availability of concomitant therapy” for 40 patients. Results and discussion. The possibilities of taking into account additional potential risks of HP for antibiotics when making an appointment list in children with nosocomial infection with the development of a critical condition are shown. In the group of children receiving concomitant therapy, the highest relative risk of developing HP for antibiotics was revealed when using tigecycline (OR 7.24; 95% CI 0.64–8.21) and meropenem (OR 1.84; 95% CI 1.01–3.36). Conclusion. The study shows the possibilities and prospects for the development of a risk-based approach when choosing combinations of antimicrobial drugs when making an appointment sheet based on an electronic medical record of an inpatient.