Antibiotics are the medications pediatricians reach for most often — and among
the easiest to overuse. Stewardship means prescribing them only when a child
truly needs them, and, when they are needed, choosing the narrowest effective
drug at the right dose, route, and duration. The goal is simple: cure the
infection while protecting the child, and the community, from avoidable harm.
Why stewardship matters for Louisiana children
Every antibiotic course carries risk alongside benefit. Beyond driving
resistance, unnecessary antibiotics expose children to C. difficile
infection, rashes, diarrhea, cytopenias, and anaphylaxis — and antibiotic
reactions account for a large share of pediatric emergency visits for adverse
drug events. The CDC estimates antibiotic-resistant infections cause roughly
3 million illnesses and 35,000 deaths in the United States each year. Growing
evidence also links frequent early-life antibiotic exposure to disruption of a
child's developing gut microbiome. Prescribing well is one of the highest-yield
ways a pediatric practice can protect its patients.
The four questions of good prescribing
When an antibiotic is genuinely indicated, stewardship comes down to four
decisions on every prescription:
- Right drug — favor the narrowest-spectrum agent that
reliably covers the likely pathogen. Broad-spectrum second-line drugs are
often prescribed where a first-line narrow agent would work just as well,
adding cost and adverse events without clinical benefit.
- Right dose — weight-based and adequate to reach the site
of infection.
- Right route — oral therapy is effective for most common
outpatient infections; reserve parenteral therapy for conditions where oral
is known to fall short.
- Right duration — for many common infections, shorter
courses work. Reflexive 10- or 14-day courses are frequently longer than the
evidence supports.
Where stewardship happens: inpatient vs. outpatient
Most pediatric antibiotic use — and most of the opportunity to improve it —
happens in the outpatient setting, where roughly one in five sick-child visits
ends in an antibiotic prescription and a large share of those are avoidable.
The tools differ by setting:
| Setting | Core stewardship strategies |
|---|
| Inpatient / hospital |
Local treatment guidelines for common syndromes; prior approval for
restricted agents; postprescription review with feedback at 48–72 hours;
pharmacy-driven dose optimization and IV-to-oral conversion; a physician
and pharmacist leader with pediatric ID expertise. |
| Outpatient / clinic, urgent care, ED |
Standardized prescribing guidance and clinical decision support;
audit-and-feedback on prescribing rates; watchful waiting where
appropriate; clinician communication training; caregiver education on the
natural course of viral illness. |
Outpatient priorities
Prescribe only when needed
Acute respiratory infections drive most pediatric antibiotic use, and a
large fraction of those prescriptions are unnecessary. Antibiotics generally
have no role in nonspecific upper respiratory infection, bronchiolitis, acute
bronchitis, asthma exacerbations, or most conjunctivitis.
Diagnose before you treat
Tighten the diagnosis first: confirmatory pneumatic otoscopy for acute
otitis media, a positive group A strep test before treating pharyngitis, and
pyuria plus symptoms (with urinalysis and culture) before treating a urinary
tract infection.
The opportunity: National estimates suggest outpatient
pediatric antibiotic prescribing could be safely reduced by about 30% without
worsening outcomes — a target well within reach of a standard-of-care primary
care practice.
Building a program in your practice
An effective outpatient program does not require a hospital's infrastructure.
It needs a committed clinician leader, a way to track and feed back prescribing
data, and a shared set of local prescribing expectations. Emphasize the
narrowest-spectrum drug for the shortest effective duration, close the loop on
antibiotics started empirically when cultures return negative, and equip your
team with brief, evidence-based scripts for the conversations parents worry
about most. LA AAP can help Louisiana practices connect with stewardship
resources and quality-improvement collaboratives.
Adapted by the Louisiana Chapter of the American Academy of Pediatrics from
the AAP/Pediatric Infectious Diseases Society policy statement
Antibiotic Stewardship in Pediatrics (Gerber JS, Jackson MA, Tamma PD,
Zaoutis TE; AAP Committee on Infectious Diseases and Pediatric Infectious
Diseases Society. Pediatrics. 2021;147(1):e2020040295; reaffirmed
September 2025). Read the full policy statement at
publications.aap.org.
This summary does not indicate an exclusive course of treatment or serve as a
standard of medical care; variations accounting for individual circumstances
may be appropriate.
