Antibiotics are being inappropriately prescribed to children, who use more antibiotics than adults and are more vulnerable to drug resistance, a new government study found.
According to a report on the appropriateness and management of antibiotic use among children and adolescents in Korea, commissioned by the Korea Disease Control and Prevention Agency (KDCA) and conducted by a research team at Bundang Seoul National University Hospital, one in three antibiotic prescriptions for children and adolescents was medically inappropriate. Prophylactic antibiotics used to prevent bacterial infections before and after surgery were misused in more than seven out of 10 cases, the report found.
The research team evaluated the appropriateness of antibiotic prescriptions at 20 medical institutions nationwide. Overall, 31.7% of prescriptions were deemed inappropriate. Surgical prophylactic antibiotics were the most problematic category, with 75.7% of prescriptions for pre- and post-operative infection prevention found to be inappropriately administered.
Antibiotics were frequently prescribed for conditions such as the common cold and acute bronchitis, where they are not medically necessary. Many cases also involved the selection of unnecessarily broad-spectrum antibiotics. Administering antibiotics beyond the recommended duration was also identified as a major contributing factor.
By antibiotic type, second-generation cephalosporins had the highest rate of inappropriate prescriptions. For intravenous administration, 65.8% were used inappropriately, while 79.5% of oral prescriptions were deemed inappropriate.
The researchers pointed to unnecessary prescriptions, the selection of excessively broad-spectrum drugs, and prolonged administration as the core drivers of antibiotic misuse in children.
In-hospital management systems were also found lacking. Antimicrobial stewardship programs (ASPs), which help ensure antibiotics are used only when necessary and in appropriate doses, were in place at 84.5% of domestic medical institutions. However, only 64.8% of those operated programs specifically tailored to children and adolescents.
Most hospitals run their management systems centered on adult patients, leaving them unable to provide detailed prescription oversight that reflects the physiological characteristics of pediatric patients.
A shortage of specialized personnel is also a serious concern. At 65.9% of surveyed institutions, there was only one pediatric infectious disease specialist. Only 4.6% had a dedicated pharmacist assigned. Experts say the workload of reviewing and managing all pediatric antibiotic prescriptions across an entire hospital is excessive for a single specialist.
Frontline experts agreed that government-led top-down policy initiatives are needed to address these issues. In an awareness survey of pediatric infectious disease subspecialists, 61.4% of respondents said government-led top-down policy would be the most effective approach. They also called for the urgent establishment of separate reimbursement fees for antibiotic stewardship activities and the introduction of an incentive system to drive meaningful change.
Based on the findings, the KDCA plans to pursue institutionalization and standardization of pediatric antibiotic management. The agency intends to develop pediatric-specific clinical guidelines and expand surgical prophylactic antibiotic oversight to include children, strengthening the national surveillance system.
