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Outpatient Pediatric Antibiotic Use: a Systematic Review

  • Healthcare Associated Infections (G Bearman, D Morgan, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The majority of pediatric antibiotic use occurs in outpatients. However, the optimal strategies for antimicrobial stewardship in this setting are unknown. We sought to identify studies relevant to pediatric outpatient stewardship that have been published in the past decade. The details of this systemic review are presented along with targets for future stewardship efforts and discussion regarding effective outpatient stewardship strategies.

Recent Findings

In 2016, the CDC released the “Core Elements of Outpatient Antibiotic Stewardship” that serve as practical guidelines to develop impactful and sustainable ASP interventions: commitment, action for policy and practice, tracking and reporting, and education and expertise. However, there has not been a recent review of the primary medical literature on pediatric outpatient stewardship. A systematic review of pediatric antibiotic control strategies published in 2007 identified 28 studies overall, 8 of which focused on outpatients. Two subsequent systematic reviews published in 2015 and 2018 intentionally excluded outpatients.

Summary

Outpatient settings are a crucial component of pediatric antimicrobial stewardship in the USA. Establishing effective stewardship interventions can protect children and optimize clinical outcomes in outpatient healthcare settings. Based on our review of the literature, it is clear that the optimal outpatient stewardship strategies remain to be elucidated. However, there is robust literature describing variability in outpatient antibiotic prescribing that can be used to target interventions.

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Abbreviations

ABS:

Acute bacterial sinusitis

AOM:

Acute otitis media

ASP:

Antimicrobial stewardship program

AR:

Antimicrobial resistance

CDC:

Centers for Disease Control

CAP:

Community-acquired pneumonia

EMR:

Electronic medical record

GAS:

Group A streptococcal pharyngitis

MeSH:

Medical Subject Heading

NAMCS:

National Ambulatory Medical Care Survey

SSTI:

Skin and soft tissue infection

URTI:

Upper respiratory tract infection

UTI:

Urinary tract infection

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Funding

Dr. Kilgore was supported by the Foundation of the National Institute of Health (T32-AI007062-40, JW Sleasman, PI, and JT Kilgore, Fellow Trainee).

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Authors and Affiliations

  1. Division of Pediatric Infectious Diseases, T915 Children’s Health Center, Duke University, Box 3499, DUMC, Durham, NC, 27710, USA

    Jacob T. Kilgore & Michael J. Smith

  2. Duke Center for Antimicrobial Stewardship and Infection Prevention, Box 102359, DUMC, Durham, NC, 27710, USA

    Michael J. Smith

Authors
  1. Jacob T. Kilgore
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Correspondence to Jacob T. Kilgore.

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Jacob T. Kilgore and Michael J. Smith declare no conflict of interest.

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Kilgore, J.T., Smith, M.J. Outpatient Pediatric Antibiotic Use: a Systematic Review. Curr Infect Dis Rep 21, 14 (2019). https://doi.org/10.1007/s11908-019-0673-x

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