A Paediatric Perspective: Opportunities and Challenges in Emergency Department Antimicrobial Stewardship

The Emergency Department (ED) represents an ideal location for antimicrobial stewardship (AMS) intervention, given the large volume of antibiotics seen prescribed to a wide variety of patients. This is particularly true in paediatrics, where most infectious presentations are viral in nature. A recent European Society of Clinical Microbiology and Infectious Diseases (ESCMID) position paper addressed four key areas affecting adult ED. This included: (1) the utility of biomarkers or rapid pathogen tests, (2) the impact of blood cultures on antibiotic prescribing, (3) the effect of watchful waiting on clinical outcomes, and (4) the potential for structured follow-up programmes within the ED to impact prescribing. Comparatively, the paediatric ED remains underrepresented in the literature with regard to AMS interventions. In this review article, we review the evidence surrounding the above four key areas as they relate to the paediatric population.