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