Optimizing antimicrobial prophylaxis use in pediatric surgery through evidence, accountability, and multidisciplinary...

Antimicrobial stewardship is essential to safe, effective pediatric surgical care, yet surgical antimicrobial prophylaxis (SAP) remains highly variable and frequently overused across children's hospitals. This review provides a high-level synthesis of the public health rationale for stewardship, the current landscape of SAP practice, and the growing body of pediatric-specific evidence informing appropriate prophylaxis use. We integrate national guideline recommendations with contemporary outcomes data and describe how benchmarking initiatives such as ACS NSQIP-Pediatric and Children's Surgery Verification programs promote accountability and standardization in perioperative antibiotic use. The review also highlights the critical role of antimicrobial stewardship programs in guiding institutional practice and supporting the development of evidence-based local protocols. Finally, we outline the broad categories of evidence-based tools and strategies that facilitate high-quality stewardship for prophylaxis use. Together, these components establish a contemporary roadmap for optimizing prophylaxis use while minimizing unnecessary antibiotic exposure in children undergoing elective surgical procedures.