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
- Pneumonia
- What's Your Game Plan for Vaccines this Fall?
- Back to School Basics to Prevent Infections
- My Oh Mycoplasma
- What is Antibiotic Challenge Testing?
- Adolescent STI Testing and Treatment Updates
- Working Towards Equitable Antibiotic Prescribing
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.
2024
- Shorter is Better: 3-5 Days of Antibiotics for Community Acquired Pneumonia
- Shifting from Stewardship to Sustainability
- Top 6 Tips and Tricks for Treating Ticks
- Animal and Human Bites - How Do You Manage?
- Managing the Child with Pharyngitis
- Acute Bacterial Rhinosinusitis – Updates and Pearls for the Pediatric Practitioner
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!
- Oral Cephalosporins for Urinary Tract Infections: Why Not Cefdinir for All?
- Removing Antimicrobial "Pebbles" - Helping You and Helping Our Community
- Bacterial Conjunctivitis... Does It Always Need Antibiotics?
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
A key component of ASPs has been ongoing monitoring of various metrics; however, recommended metrics do not adequately depict the direct impact of the ASP on patient safety, which is an important metric for both hospital leadership who are charged with resource allocation and frontline teams who are responsible for implementing change. There is a need for an objective, quantifiable measure to assess antimicrobial-associated patient harm avoided due to ASP intervention. In this publication, our ASP describes the development of a novel metric—the Antimicrobial Stewardship Impact Scoring Tool (ASIST)—which associates each inpatient ASP prospective audit and feedback (PAF) intervention with a level (high, moderate, low impact) of patient harm prevention and antimicrobial optimization.
Wirtz AL, Burns AN, Monsees EA, Lee BR, Herigon JC. Development and implementation of the antimicrobial intervention scoring tool (ASIST) at a single pediatric institution. Infect Control Hosp Epidemiol. 2024;16:1-6. PMID: 39279733.
Sociodemographic Differences in Treatment of Acute Respiratory Infections in Pediatric Urgent Cares
Reports from primary care clinics, urgent care clinics, and emergency departments show high rates of antibiotic use and non-first-line antibiotic use in White non-Hispanic children compared to other races and ethnicities. Differences in management of patients with common infections have been shown to persist across race, ethnicity, insurance status, and language. These differences in antibiotic use suggest that health inequities may exist. In this publication, our ASP utilizes data obtained from 9 institutions participating in a Children's Mercy-led multicenter collaborative (REDUCE) to determine whether differences exist in antibiotic prescribing for respiratory infections in pediatric urgent care centers by patient race/ethnicity, insurance, and language.
El Feghaly RE, Sainz LE, Lee BR, Kronman MP, Hersh AL, Parente V, Bizune D, Sanchez GV, Hamdy RF, Nedved A; For REDUCE (Reducing Differences in Urgent Care Encounters – Antibiotic Choice) Collaborative. Sociodemographic differences in treatment of acute respiratory infections in pediatric urgent cares. Infect Control Hosp Epidemiol. 2024 Dec 3:1-9. doi: 10.1017/ice.2024.196. Epub ahead of print. PMID: 39623533.
At the Break Point: What Needs to Change for Antimicrobial Stewardship Program Pharmacists?
The dual threats of antimicrobial resistance and antimicrobial-related patient harm are only increasing. Antimicrobial stewardship is needed now more than ever. Strong, well-trained, experienced ASP pharmacists are critical for successful stewardship and protecting our patients. However, many ASP pharmacists "burn out by the time they are in their mid-30s." In this publication, members of the Children's Mercy ASP partner with ASP team members from external institutions to list modifiable contributors to burnout for ASP pharmacists and provide action steps for health systems, pharmacy departments, and ASP leadership to promote change.
Wirtz AL, Metjian TA, Parker SK, Herigon J, MacBrayne CE. At the break point: What needs to change for antimicrobial stewardship program pharmacists? Am J Health Syst Pharm. 2024;81(24):1322-1326.
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.