Antibiotics save lives when
prescribed carefully to fight infection, but their overuse has led to a
well-known phenomenon of resistance that can render those medications useless.
The American Academy of
Pediatrics, as part of the Choosing Wisely® campaign, wants to protect
hospitalized children from the effects of antibiotic resistance by providing a
list of recommendations to serve as a starting point of conversation for
physicians and patients.
“It’s important to select the
right antibiotic dose at the right time for the right duration,” said Theoklis
Zaoutis, MD, FAAP, a member of the AAP Committee on Infectious Diseases. “Some
antibiotics that are routinely prescribed to attack a broad spectrum of
disease-causing bacteria are not necessary and may contribute to this problem
Experts acknowledge that certain
illnesses warrant antibiotic use, but these medications should be used only for
patients at high risk of having a bacterial infection and, when indicated, for
the shortest duration possible based on scientific evidence. Ultimately, the
decision is made at the discretion of the medical team.
Pediatric infectious diseases
and fetus and newborn experts from the AAP and the Pediatric Infectious
Diseases Society collaborated to develop the list of practices.
The five items that physicians
and patients should question on the Choosing Wisely List of Antibiotic Stewardship in Hospitalized Children are:
Before antibiotics are
prescribed, testing of the patient’s blood, urine and other appropriate
cultures should be undertaken to confirm suspected invasive bacterial
During surgery, the dose and timing of antibiotics to
prevent infection are important for optimal effect, and should not be used
Ampicillin is the first choice of treatment for
children hospitalized with community-acquired pneumonia who are otherwise
healthy and immunized. Broader-spectrum antibiotics, such as
cephalosporins, have been shown to contribute to antibiotic resistance and
are often unnecessary.
Antibiotics such as vancomycin or carbapenems should be
avoided unless a child is known to have a specific risk for pathogens that
are resistant to other antibiotics.
Avoid using prolonged courses of IV antibiotics. For
most infections, children respond well to orally administered antibiotics
after a brief course of intravenous therapy. Peripherally inserted central
catheters, used to facilitate prolonged courses of IV antibiotics, often
result in complications.
“We want to see children get healthy as soon as possible
while avoiding the potential harms of antibiotic overuse,” said Jeff Gerber,
MD, FAAP, also a member of the AAP Committee on Infectious Diseases.
“Ultimately, the decision is left to the discretion of the medical team.”
Choosing Wisely® is an initiative of the ABIM Foundation,
which seeks to promote conversations between clinicians and patients in
choosing care that is supported by evidence; does not duplicate other tests or
procedures already received; is free from harm; and truly necessary.
At least 80
medical specialty societies have published more than 500 recommendations of
overused tests and treatments as a result of the initiative, launched in 2012.
The list for antibiotic stewardship can be found