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Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review
  1. André Ricardo Araujo da Silva1,
  2. Amanda Marques1,
  3. Clara Di Biase1,
  4. Monique Faitanin1,
  5. Indah Murni2,
  6. Angela Dramowski3,
  7. Johannes Hübner4,
  8. Walter Zingg5
  1. 1 Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
  2. 2 Gadjah Mada University, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia
  3. 3 Stellenbosch University, Cape Town, Western Cape, South Africa
  4. 4 University Children's Hospital at Dr. von Haunersches Kinderspital, LMU Munich, Munich, Germany
  5. 5 Geneva University Hospitals, Geneva, Switzerland
  1. Correspondence to Professor André Ricardo Araujo da Silva, Universidade Federal Fluminense, Niteroi 24220-900, Brazil; aricardo{at}


Introduction Antimicrobial stewardship programmes (ASPs) are recommended to improve antibiotic use in healthcare and reduce antimicrobial resistance (AMR). Our aim was to investigate the effectiveness of ASPs in reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, antibiotic resistance and healthcare-associated infections (HAIs) in neonates.

Methods We searched PUBMED, SCIELO, EMBASE and the Cochrane Database (January 2000–April 2019) to identify studies on the effectiveness of ASPs in neonatal wards and/or neonatal intensive care units (NICUs). Outcomes were as follows: reduction of antibiotic consumption overall and of broad-spectrum/target antibiotics, inappropriate antibiotic use, antibiotic resistance and HAIs. ASPs conducted in settings other than acute care hospitals, for children older than 1 month, and ASPs addressing antifungal and antiviral agents, were excluded.

Results The initial search identified 53 173 titles and abstracts; following the application of filters and inclusion criteria, a total of six publications were included in the final analysis. All studies, of which one was multi-centre study, were published after 2010. Five studies were conducted exclusively in NICUs. Four articles applied multimodal interventions. Reduction of antibiotic consumption overall and/or inappropriate antibiotic use were reported by four articles; reduction of broad-spectrum/targeted antibiotics were reported by four studies; No article evaluated the impact of ASPs on AMR or the incidence of HAI in neonates.

Conclusion ASPs can be effectively applied in neonatal settings. Limiting the use of broad-spectrum antibiotics and shorting the duration of antibiotic treatment are the most promising approaches. The impact of ASPs on AMR and HAI needs to be evaluated in long-term studies.

  • systematic review
  • neonates
  • antimicrobial stewardship
  • antibiotic consumption
  • antibiotic resistance

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  • Contributors ARAS: Conception and design of the study, data collection and analysis, writing the first draft of the manuscript, final approval of the version to be submitted. CBB, MF: Data collection and analysis, reviewing and contribution to subsequent drafts of the manuscript, final approval of the version to be submitted. AFF: Reviewing and contribution to subsequent drafts of the manuscript, final approval of the version to be submitted. IKM, AD, JH, WZ: drafting the article, reviewing and contribution to subsequent drafts of the manuscript, final approval of the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.