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Discharge antibiotic prescribing at children's hospitals with established antimicrobial stewardship programs

Rebecca G Same1,2, Giyoung Lee2,3, Jared Olson4

  • 1Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Infection Control and Hospital Epidemiology
|April 8, 2025
PubMed

Insights

Most pediatric discharge antibiotic prescriptions for pneumonia, UTI, and skin infections were suboptimal. This highlights a key area for improving antibiotic use in children through better antibiotic stewardship programs.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Pharmacology

Background:

  • Antibiotic stewardship programs (ASPs) often focus on inpatient antibiotic use.
  • Discharge antibiotic prescribing in children is a significant, yet often overlooked, aspect of care.
  • A substantial proportion of discharged children receive continued antibiotic therapy.

Purpose of the Study:

  • To evaluate antibiotic prescribing practices at discharge for common pediatric infections.
  • To assess the optimality of antibiotic choice and duration for community-acquired pneumonia (CAP), urinary tract infection (UTI), and skin/soft tissue infection (SSTI).

Main Methods:

  • Retrospective cohort study involving 1,206 pediatric encounters across four academic children's hospitals.
  • Analysis of antibiotic choice and total duration of therapy (DOT) against national guidelines.
  • Inclusion criteria focused on uncomplicated CAP, UTI, and SSTI in children under 18.

Main Results:

  • Optimal antibiotic choice was observed in 77% of cases, but optimal DOT was only achieved in 26%.
  • Only 20% of antibiotic courses met both optimal choice and DOT criteria.
  • Suboptimal prescribing (either choice or DOT) occurred in 80% of discharge antibiotic courses.

Conclusions:

  • Discharge antibiotic prescribing for pediatric CAP, UTI, and SSTI is frequently suboptimal.
  • There is a significant opportunity to enhance antibiotic use in children by optimizing discharge prescriptions.
  • Strengthening ASPs to include discharge prescribing is crucial for improving pediatric antibiotic therapy.
Abstract

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