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HOMEFREE: Scaling-Up Evidence-Based Guidelines for IV-to-Oral Antibiotic Switch in Hospitalised Children, an
Jessica Suna1,2, Daniel Tanti3,4, Adam Bartlett3,4
1University of Queensland, Brisbane, Australia.
Journal of Paediatrics and Child Health
|August 6, 2026
Summary
Implementing IV-to-oral antibiotic switch guidelines for children significantly improves timely transitions, reducing hospital costs and complications. This study assesses scaling this successful approach across diverse Australian hospitals.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Health Services Research
Background:
- Intravenous (IV) antibiotics are common in hospitalized children, leading to increased costs and complications.
- A pilot program using Australasian Stewardship of Antimicrobials in Paediatrics (ANZPID-ASAP) guidelines improved IV-to-oral switch rates from 64% to 82% in a tertiary pediatric hospital.
- A larger study is planned to evaluate the feasibility of scaling this intervention across various hospital types in NSW, Australia.
Purpose of the Study:
- To test the hypothesis that an IV-to-oral antibiotic switch program, guided by ANZPID-ASAP, audit, and feedback, increases timely transitions to oral therapy or antibiotic cessation in hospitalized children.
- To evaluate the effectiveness and implementation feasibility of this program in tertiary pediatric and general hospitals, including metropolitan and rural settings.
- To present the HOMEFREE study protocol for a multi-site trial.
Main Methods:
- Prospective audits will assess effectiveness, focusing on timely guideline-concordant IV-to-oral switches and hospital length of stay.
- Sites will implement context-specific interventions to support guideline adherence, informed by shared learning.
- Implementation feasibility will be evaluated using the Consolidated Framework for Implementation Research via surveys before and after 12 months of audit and feedback.
Main Results:
- The study protocol is presented, outlining the methodology for assessing the intervention's impact.
- Key outcomes include the proportion of children switched to oral therapy or having antibiotics ceased within 24 hours of eligibility.
- Implementation feasibility will be measured through changes in adherence to guidelines and stakeholder perceptions.
Conclusions:
- This study aims to determine the effectiveness and feasibility of implementing and scaling best-practice IV-to-oral antibiotic switch guidelines for pediatric patients.
- The findings will inform wider adoption of antimicrobial stewardship strategies to optimize antibiotic use in children.
- Successful scaling could lead to reduced healthcare costs, fewer complications, and shorter hospital stays for pediatric patients.
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