Standards of Antimicrobial Stewardship in Children’s Health Queensland
- Take cultures before starting antibiotics
- Cease antibiotics if cultures negative at 48 hours except if:
- the child has signs of severe sepsis
- cultures were taken after antibiotic treatment was started (discuss with ID specialist)
- ongoing infection is likely
- Change to narrow spectrum antibiotics once sensitivities are known
- Consult ID specialist
- to confirm appropriate treatment and duration for positive blood culture results
- when escalation to broader antibiotic treatment is considered for ongoing infection
- for recommendations for treatment duration in confirmed infections
- Document indication and planned duration/review date on Paediatric National Inpatient Medication Chart when prescribing antimicrobials (use “Comments” , e.g. “Cefotaxime 500mg every 6 hours IV. Indication: Meningitis. Review date: Review at 48hours”)
- Daily review of antibiotic plan (stop/continue antibiotics) should occur during ward round, review is to include:
- Consideration of Early IV to Oral Switch Therapy – Patients should be reviewed at 24 to 48 hours to consider whether early IV to oral switch would be appropriate. Refer to the LCCH Paediatric guideline Antimicrobial Treatment: Early Intravenous to Oral Switch for further information.
- Exercise caution when considering a switch to oral in neonates and infants because of the relatively high incidence of bacteraemia and the possibility of variable oral absorption.
- Review of pathology results and appropriate antimicrobial dosing and choice based on these results.
- Seek pharmacist/ID advice on appropriate therapeutic drug monitoring (TDM) and appropriate dosing for patients in renal failure
- Paediatric Tobramycin/Gentamicin Therapeutic drug monitoring
- Paediatric Vancomycin Therapeutic drug monitoring
