Understanding Antimicrobial Stewardship in Paediatric Practice: A Conceptual Framework

Abstract

Abstract

Antimicrobial resistance (AMR) poses a significant global health threat, with 5 million deaths linked to bacterial AMR in 2021, projected to reach 10 million by 2050. Low- and middle-income countries (LMICs) like Nigeria face a high AMR burden, particularly among children under 5, driven by infectious diseases such as neonatal sepsis and respiratory infections. Inappropriate antibiotic use, fuelled by limited diagnostics, unregulated access, and poor regulatory frameworks, exacerbates this crisis. Nigeria’s National Action Plan (NAP) 2.0 (2024) prioritizes antimicrobial stewardship (AMS) in healthcare facilities, yet pediatric AMS programs are scarce due to low awareness, skill gaps, and communication challenges. This review outlines the state of AMS in Nigeria, emphasizing the need for paediatric-specific programs to combat AMR and reduce under-5 mortality. A conceptual framework is proposed to streamline AMS implementation, linking inputs (human resources, infrastructure, policies), processes (audits, guidelines, education), and outputs (rational antibiotic use, reduced AMR). The framework highlights synergy with Infection Prevention and Control, Diagnostic Stewardship Programmes, Patient safety and behavioural change interventions. Key recommendations include establishing multidisciplinary AMS teams, investments in point-of-care diagnostics, training, and digital tools like e-prescribing. The Nigerian Society for Paediatric Infectious Diseases AMS network, modelled on the UK-PAS, can drive advocacy and training.