Improve pediatric antimicrobial use

OPTIMIZE DOSES. For instance, use higher doses for certain infections, such as Q8H cefepime for febrile neutropenia...
Abdelwahab Ward, BS Pharm, PharmD

YOUR HOSPITAL WILL CONTINUE to expand its antimicrobial stewardship program for pediatric patients. Most stewardship approaches are similar to adults (local antibiotic guidelines, antibiograms, restricted antimicrobials, etc). But be prepared for peds-specific considerations, such as the need for a pediatric-specific antibiogram. Antimicrobial resistance to E. coli and other bacteria may differ from adults.

          AVOID ANTIMICROBIAL OVERUSE. For instance, antibiotics are commonly started empirically for early-onset neonatal sepsis. But evaluate when observation can be used instead for low-risk patients. For example, consider observing for up to 48 hours if mom did NOT get adequate group B strep prophylaxis, but the newborn is at least 35 weeks and well-appearing.

OPTIMIZE DOSES. For instance, use higher doses for certain infections, such as Q8H cefepime for febrile neutropenia, meningitis, or some acute cystic fibrosis pulmonary infections instead of Q12H. Check that your EHR caps weight-based doses, so they don't exceed adult doses. For example, ceftriaxone 50 mg/kg for pneumonia in a 50 kg child would be 2500 mg, but cap at 2000 mg instead.

USE SHOTER DURATIONS WHEN POSSIBLE. For instance, new evidence supports shorter antibiotic courses in kids with community-acquired pneumonia discharged from the emergency department (ED). Think about using 5 days of high-dose amoxicillin in these patients instead of 10 days.

INVESTIGATE REPORTED ALLERGIES. For example, a child taking penicillin for a suspected bacterial infection may actually have a virus. If a rash develops, it might be from the virus not the penicillin. Consider penicillin skin testing or assess risk based on history. A patient with a mild rash or itching when previously taking penicillin can often try it again.

PROMOTE IV-to-PO OPPORTUNITIES. For instance, some antibiotics (clindamycin, oseltamivir, etc) can taste bad. Advise taking with chocolate syrup or using a popsicle to numb taste buds.

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Abdelwahab Ward, BS Pharm, PharmD