Provider resources for antimicrobial stewardship
A pediatric guide from Children's Mercy Kansas City
The following resources may be helpful in staying up to date on current best practices in antimicrobial stewardship.
Pediatric Outpatient Antibiotic Handbook
The Children’s Mercy Antimicrobial Stewardship Program (ASP) developed the Outpatient Antibiotic Handbook as guidance for providers who treat common pediatric infections, such as Acute Otitis Media, Group A Streptococcal Pharyngitis, Community Acquired Pneumonia, Sinusitis, UTI, Skin and Soft Tissue Infections, Animal/Human Bites, Lymphadenitis, Bacterial Conjunctivitis, and Dental Abscesses. The handbook contains diagnostic pearls as well as guidance on antibiotic selection, allergy alternatives, dosing and duration of treatment.
Access the Outpatient Antibiotic Handbook
“Stewie Shares” infographics
Each month, our ASP team publishes an educational infographic entitled “Stewie Shares.” These provide brief, organized education targeted at both the clinician and non-clinician.
2024
2023
- The Short on Antibiotic Shortages
- We Love Antibiotics!
- Food for Thought: How are Antibiotics Impacted by What We Eat?
- Antibiotic Prescriptions: Lessons from an Outpatient Pharmacist
- Find the Just-Right Treatment Length
- Non-Human use of Antibiotics
- Diagnostic Stewardship
- Penicillin allergy
- RSV prevention
- Stewardship school
- Good Food, Good Family, Good Antibiotic Prescribing
2022
- What's New with Vaccines
- What You Should Know About Ear Infections
- Skin and Soft Tissue Infections
- Play it Safe: Medication Safety and Antibiotics
- Children's Mercy Antibiogram Update
- Bits on Animal Bites
- A Not Too DIFFicult C. Diff Review
- Strep Throat: A Common Conundrum
- Penicillin Allergies: What’s True and What to Do?
2021
- Prescribing an Antibiotic? Tidbits to Teach Families
- A Consumer’s Guide to Fluoroquinolones
- Dispose Antibiotics Safely. Prevent Resistance.
- Five Facts about Community Acquired Pneumonia
- Five Helpful Tips to Make Giving Antibiotics Easier for You and Your Child
- Flu Who? Reviewing the Prevention and Treatment of Influenza
- Four Vaccines You Didn’t Know You Needed
- IV is not Always the Answer
- Preventing RSV… As Easy as 1,2,3
- “Tick” Talk
“Wise Use of Antibiotics” column in The Link
Articles written by our ASP team on various antimicrobial stewardship practices are published in the monthly digital newsletter, The Link, which is available for all pediatric providers. Subscribe to receive The Link directly to your email each month.
2023
- Simplifying the Science: The Treatment of Group A Streptococcal Infections
- Diagnostic Stewardship: Ushering in a New Era of Stewardship
- My Oh My! Antibiotics in Short Supply!
2022
- Is My Patient Truly Allergic to Amoxicillin?
- Oral Cephalosporins for Respiratory Infections: Not Always Better
- Delayed Antibiotics for Acute Otitis Media: A Success Story
- Diagnosing and Treating Pediatric Urinary Tract Infections--What's New?
- Tick Talk: An Overview of Tickborne Infections and Treatment in the Midwest
- Management of Community-Acquired Pneumonia in the Era of COVID-19
2021
- Decoding Microbiology Results: Clinical Applications of Culture and Susceptibilities
- What is Antibiotic Stewardship and Why is it Important in Pediatrics?
- What’s the Fuss with Fluoroquinolones?
- Skin and Soft Tissue Infection Management, Longer Does Not Always Equal Better
- Intersection Between Awareness and Action: Race and Ethnicity in Antimicrobial Stewardship
- Prescribing Antibiotics? Tidbits to Teach Families
Featured Publications
Considerations for Implementation: Pediatric Outpatient Antibiotic Stewardship Program
A majority of antibiotic prescribing occurs in the outpatient setting with at least a third of prescriptions rendered unnecessary1. Pediatric antibiotic prescribing occurs more commonly in non-pediatric emergency departments, with a high use of antibiotics when not indicated and an increased selection of broad-spectrum agents2. In this publication, our antimicrobial stewardship program (ASP) presents considerations unique to pediatric populations for adult providers and infection preventionists seeking to incorporate outpatient antimicrobial stewardship elements to optimize pediatric care.
Monsees EA, Burns AN, Lee BR, Wirtz A, El Feghaly RE. Considerations for implementation: Pediatric outpatient antimicrobial stewardship program. Am J Infect Control. 2021 Aug 4:S0196-6553(21)00514-9. doi: 10.1016/j.ajic.2021.07.017. Epub ahead of print. PMID: 34358544.
Integration of a Lean Daily Management System into an Antimicrobial Stewardship Program
Growing demands and limited guidance on how to efficiently use resources to advance antimicrobial stewardship initiatives challenge ASPs. There is a universal need to optimize time and assets within ASP by fully engaging each member of the ASP. In this publication, our ASP describes our experience and process with implementing a Lean Daily Management system through a weekly huddle at our Readiness and Metrics Board.
Wirtz AL, Monsees EA, Gibbs KA, Myers AL, Burns AN, Lee BR, El Feghaly RE, Weddle GM, Day JC, Purandare AV, Goldman JL. Integration of a Lean Daily Management System into an Antimicrobial Stewardship Program. Pediatr Qual Saf. 2021 Mar 10;6(2):e384. doi: 10.1097/pq9.0000000000000384. PMID: 33718745; PMCID: PMC7952113
The Critical Role of Nurses in Antibiotic Stewardship
The Centers for Disease Control and Prevention (CDC) and American Nurses Association (ANA) identify staff nurses as critical players in the antibiotic stewardship movement. Nurses practice across the care continuum, often in settings where infectious diseases experts are lacking. As the largest discipline in healthcare, with significant influence on care, nurses are uniquely positioned to support stewardship strategies by assessing for an accurate allergy history, obtaining necessary cultures before antibiotics are administered, assessing for adverse events, managing clinical progress through outpatient management, and providing education to ensure antibiotic adherence.
Integrating bedside nurses into antibiotic stewardship: A practical approach
Monsees EA, Tamma PD, Cosgrove SE, Miller MA, Fabre V. Integrating bedside nurses into antibiotic stewardship: A practical approach. Infect Control Hosp Epidemiol. 2019 May;40(5):579-584. doi: 10.1017/ice.2018.362. Epub 2019 Feb 21. PMID: 30786944.
Implementation of a nurse-driven antibiotic engagement tool in 3 hospitals
Monsees E, Lee B, Wirtz A, Goldman J. Implementation of a nurse-driven antibiotic engagement tool in 3 hospitals. Am J Infect Control. 2020 Dec;48(12):1415-1421. doi: 10.1016/j.ajic.2020.07.002. Epub 2020 Jul 6. PMID: 32645472.
References
- Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA 2016;315:1864-73.
- Poole NM, Shapiro DJ, Fleming-Dutra KE, Hicks LA, Hersh AL, Kronman MP. Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014. Pediatrics 2019;143.