Choosing Wisely: 5 Antibiotic Strategies to Avoid in Children

The American Academy of Pediatrics offers five antibiotic strategies clinicians should question or avoid in pediatric patients, as part of the Choosing Wisely campaign. Among them:
  • For patients with suspected bacterial infection, clinicians should generally not start antibiotics until they have obtained blood, urine, or other cultures.
  • Broad-spectrum antimicrobials shouldn’t be used for perioperative prophylaxis in uncomplicated clean and clean-contaminated procedures because they carry risks and have not been shown to be more beneficial than narrow-spectrum antibiotics. Additionally, perioperative prophylaxis should not continue after the incision is closed.
  • Antibiotic therapy broader than ampicillin should be avoided in otherwise healthy, immunized, hospitalized patients with uncomplicated community-acquired pneumonia.
  • Empirical vancomycin or carbapenem use should be avoided in neonatal intensive care patients unless the infant has a risk for organisms resistant to narrower-spectrum agents.
  • Peripherally inserted central catheters or prolonged IV antibiotics shouldn’t be used in otherwise healthy children with infections if they can switch to an oral antimicrobial drug.


American Academy of Pediatrics- Committee on Infectious Diseases and the Pediatric Infectious Diseases Society (includes link to downloadable pdf)

Autism: Antibiotics and the Microbiome

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