Addressing the Silent Pandemic: The Role of Italian Primary Care Paediatrics in Combating Antimicrobial Resistance

In Italy, AMR is estimated to cause over 11 000 deaths each year—accounting for one-third of all AMR-related deaths in Europe, with a significant proportion occurring in younger individuals [2]. In this context, family paediatricians are pivotal. Their trusted relationships with families position them as central figures in promoting judicious antibiotic use and raising public awareness about infection prevention. The most recent AIFA National Report on Antibiotic Use in Italy (2023) underscores critical and persistent issues in paediatric prescribing, placing renewed responsibility on primary care paediatricians [3]. In 2023, 40.9% of children aged 0–13 years received at least one systemic antibiotic—up from 33.7% in 2022. Many of these prescriptions were deemed inappropriate, particularly among children aged 2–5 years, in whom viral infections are the most common cause of fever and respiratory symptoms [3]. There has also been a notable decline in adherence to clinical guidelines, coupled with increased use of broad-spectrum antibiotics. Only 54.4% of prescriptions were from the WHO ‘Access’ group, well below the EU's 65% target [2, 4]. Significant regional disparities persist; in Northern Italy, 37.7% of children receive antibiotics, compared to 44.1% in the South [4]. Moreover, broad-spectrum antibiotics such as macrolides and third-generation cephalosporins are heavily overused in southern regions, while narrower-spectrum penicillin remains more common in the North [4]. The amoxicillin/amoxicillin-clavulanate ratio—an established quality indicator—is 0.61 in the North but just 0.20 in the South [4]. Even more striking is the broad-to-narrow spectrum antibiotic ratio: 10.9 in the South versus 2.8 in the North, highlighting how Italy continues to lag behind European benchmarks [4]. These findings cast serious doubt on whether the PNCAR 2022–2025 target of a ≥ 20% reduction in this ratio can be met [4].