Antibiotics in critically ill children-a narrative review on different aspects of a rational approach

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Antimicrobial stewardship

Background:

• Critically ill children face significant risks from antibiotic overtreatment, primarily driven by the fear of missing severe bacterial infections.
• Adverse effects and the development of multi-drug resistant bacteria are often secondary considerations in clinical decision-making regarding antibiotic use.

Purpose of the Study:

• To review the harms associated with antibiotic treatment in critically ill children.
• To explore strategies for reducing antibiotic overtreatment without compromising patient safety.
• To align evidence-based practices with current Surviving Sepsis Campaign guidelines.

Main Methods:

• This narrative review synthesizes existing literature on antibiotic use in critically ill children.
• It examines diagnostic approaches, the utility of biomarkers, optimal timing of antibiotic therapy, empiric versus targeted treatment, and therapeutic drug monitoring.
• Evidence presented is linked to recommendations from the Surviving Sepsis Campaign guidelines.

Main Results:

• Overuse of antibiotics in critically ill children can lead to significant harm.
• Immediate broad-spectrum antibiotic administration is crucial for hemodynamically unstable children with suspected infections.
• Hemodynamically stable children with sepsis and organ dysfunction may benefit from a diagnostic window of up to 3 hours before initiating antibiotics.

Conclusions:

• Antibiotic stewardship programs are essential for guiding appropriate antibiotic therapy in critically ill children.
• Implementing targeted and judicious antibiotic use can mitigate risks and improve patient outcomes.
• Balancing the need for prompt treatment with diagnostic evaluation is key to effective antimicrobial management.