Pediatric Antimicrobial Stewardship

Antimicrobial stewardship is a term used to describe the practice of improving the meaningful and appropriate use of antimicrobials. At Baylor College of Medicine, the pediatric antimicrobial stewardship team strives to ensure that antimicrobials prescribed in inpatient and outpatient settings are prescribed appropriately, accounting for patient clinical presentation, diagnosis, antibiotic allergies, and adherence to clinical care guidelines. Antibiotic overuse is a primary driver of antibiotic resistance, and antibiotic resistant bacteria are a continuing problem in our community. Antimicrobial stewardship – in which everyone is a critical player – is essential to ensure we continue to use the safest and most effective medications we have for years to come.

Inpatient Antimicrobial Stewardship

The pediatric antimicrobial stewardship team conducts a variety of activities at Texas Children’s Hospital campuses (Medical Center, West Campus, Woodlands, and Austin) to improve the use of antimicrobials among children, in line with the CDC Core Elements of Antimicrobial Stewardship.

Activities include:

• Antibiotic tracking and reporting
• Prescribing audit and feedback (aka “Handshake Rounds”)
• Monitoring of restricted antimicrobials
• Diagnostic stewardship
• Management of antimicrobial drug shortages
• Creation of surgical prophylaxis and other evidence-based guidelines

Outpatient Antimicrobial Stewardship

The antimicrobial stewardship team at Baylor College of Medicine and Texas Children’s Hospital have recently published the TCH Outpatient Antibiotic Handbook. A download will be available (anticipated, Fall 2024).

The purpose of this handbook is to provide guidance on the management of common outpatient pediatric infections, including the management of common respiratory tract infections in children with antibiotic allergies and the treatment of recurrent streptococcal pharyngitis and urinary tract infections caused by extended spectrum beta lactamase (ESBL) producing organisms.

Penicillin Allergy De-Labeling

Penicillin allergies are the most common drug allergy labels, but most children labeled as penicillin allergic tolerate penicillin following formal allergy testing. Penicillin derivatives are the treatment of choice for many common respiratory tract infections in children. Therefore, addressing unconfirmed penicillin allergy labels is a priority for antimicrobial stewardship programs.

The BCM Antimicrobial Stewardship Team has partnered with the BCM Pediatric Immunology, Allergy, and Retrovirology Division to establish a penicillin allergy stewardship program for the pediatric community in the greater Houston region. Children with unconfirmed penicillin allergies may be referred to either the pediatric infectious diseases or pediatric allergy and immunology divisions where they will be scheduled for formal penicillin allergy evaluation.