oa Pediatric pneumococcal immunization programs and associated changes in antibiotic utilization: A systematic review

Background and Objectives: Antimicrobial stewardship is rapidly becoming very popular throughout the Middle East and abroad. Immunization programs, as a form of disease prevention, may reduce utilization of antimicrobials by decreasing incidence of disease requiring treatment. This may be especially important in children, as exposure to antimicrobials has been associated with chronic diseases such as asthma. The objective of this review is to summarize and evaluate the literature pertaining to antimicrobial utilization with respect to implementation of pneumococcal immunization programs or within clinical studies assessing vaccine effectiveness. Methods: A literature search was performed using the search terms: vaccine; immunization; antimicrobial; antibiotic; and pneumococcal in MEDLINE (1948-August 2012), EMBASE (1980-August 2012), International Pharmaceutical Abstracts (1970-August 2012), Google, and Google Scholar. Articles were limited to those describing pediatric populations. Identified clinical or epidemiological studies were included if antimicrobial utilization was listed as a reported outcome. Results: Five articles (two randomized controlled trials and three epidemiological studies) were identified and included in the review. All studies reported decreased antibiotic use associated with initiation of immunization programs or increased uptake of available vaccines. Epidemiological studies showing population-wide decreases reflected the results observed from short-term randomized controlled trials. Antibiotic reductions ranged from 5-10% in randomized controlled trials and up to relative reductions of approximately 40% in epidemiological studies. Conclusions: These findings suggest that pneumococcal immunization programs may reduce antibiotic utilization in pediatric populations. As such, vaccination status queries and updates should become part of routine care for patients in medical centers and in the community. Future research is needed to determine if these results are similar in adult recipients of the pneumococcal vaccine, such as the elderly. Pneumococcal vaccination programs could be considered part of nationally and internationally recommended strategies to reduce utilization of antibiotics in pediatric patients.