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FYI: Antibiotic stewardship in pediatric hospital patients :

November 12, 2018
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Selecting the right antibiotic dose at the right time for the right duration can go a long way to reduce the effects of antimicrobial resistance in hospitalized pediatric patients.

Pediatric infectious diseases and fetus and newborn experts from the AAP and Pediatric Infectious Diseases Society collaborated on a list of five things physicians and patients should question. List items were selected based on whether they were feasible, evidence-based, not duplicative, free from harm and truly necessary.

The list is part of Choosing Wisely, an initiative supported by the AAP to help pediatricians start conversations with families about the necessity of medical tests, treatments and procedures.

For this list, Antibiotic Stewardship in Hospitalized Children, experts acknowledged that sudden, inexplicable onset of severe illness in an individual hospital patient might warrant short-term, empiric broad-spectrum antibiotic use. Ultimately, the decision is made at the discretion of the medical team.

Pediatricians can pause and choose wisely on the following:

  1. Don’t initiate empiric antibiotic therapy in the patient with suspected invasive bacterial infection without first confirming that blood, urine or other appropriate cultures have been obtained, excluding exceptional cases.
  2. Don’t use a broad-spectrum antimicrobial agent for perioperative prophylaxis or continue prophylaxis after the incision is closed for uncomplicated clean and clean-contaminated procedures.
  3. Don’t treat uncomplicated community-acquired pneumonia in otherwise healthy, immunized, hospitalized patients with antibiotic therapy broader than ampicillin.
  4. Don’t use vancomycin or carbapenems empirically for neonatal intensive care patients unless an infant is known to have a specific risk for pathogens resistant to narrower-spectrum agents.
  5. Don’t place peripherally inserted central catheters and/or use prolonged IV antibiotics in otherwise healthy children with infections that can be transitioned to an appropriate oral agent.

Visit www.aap.org/choosingwisely for descriptions and references for this list, to view all AAP lists and to access the Choosing Wisely app for Android or Apple.

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