The American Academy of Pediatrics (AAP) released new guidelines for treating hospitalized children in need of antibiotics. The recommendations are part of the AAP's Choosing Wisely campaign. Highlights include:

* Before starting antibiotics for a suspected bacterial infection, blood or urine should be cultured to confirm the organism and the need for an antibiotic. Polymerase chain reaction testing may be helpful for infections of cerebrospinal, synovial, and pleural fluids. Antiviral drugs should replace antibiotics if bacterial infection is excluded.

* Use narrow-spectrum antibiotics when treating community-acquired pneumonia (CAP) in children. Streptococcus pneumoniae is the most common cause of CAP in healthy, immunized children, and most strains are susceptible to ampicillin/penicillin. Broad-spectrum antibiotics may be needed for complicated CAP including empyema, or in hospitals with high endemic rates of resistant organisms.

* Broad-spectrum vancomycin or carbapenems should be used in the neonatal ICU only for infants known to be colonized with methicillin-resistant Staphylococcus aureus. Empiric use of vancomycin offers no survival benefit, and its overuse can lead to antibiotic resistance.

* Use narrow-spectrum antibiotics for perioperative prophylaxis. In uncomplicated clean or clean-contaminated procedures (those that cross the respiratory, gastrointestinal, or urogenital tract), prophylaxis should be discontinued after the incision is closed.

* When a prolonged course of antibiotics is needed, avoid the use of peripherally inserted central catheters, which do not improve cure rates and often lead to complications. Most children respond well to oral antibiotics after a brief course of IV antibiotics.

"Because nurses work closely with patients and their families in the hospital, they can play a key role in optimizing antibiotic use," said Theoklis Zaoutis, professor of pediatrics at the Children's Hospital of Philadelphia and an author of the recommendations. "Nurses can be advocates, educators, and ambassadors for widespread behavioral changes to promote awareness of antibiotic resistance," Zaoutis told AJN.

Read more at http://www.choosingwisely.org/societies/american-academy-of-pediatrics-committee.-Carol Potera