title: Variation in paediatric hospital antibiotic guidelines in Europe.
abstract: OBJECTIVE
  To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics.
  
  
  METHODS
  Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children.
  
  
  RESULTS
  84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy.
  
  
  CONCLUSIONS
  Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.
authors.affiliation: Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Spyridis
authors.affiliation: Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Syridou
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Goossens
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Versporten
authors.affiliation: Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece.
authors.forename: J
authors.initials: J
authors.lastname: Kopsidas
authors.affiliation: Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Kourlaba
authors.affiliation: Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Bielicki
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Drapier
authors.affiliation: Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: T
authors.initials: T
authors.lastname: Zaoutis
authors.affiliation: Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Tsolia
authors.affiliation: Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Sharland
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D005060:Europe; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D012141:Respiratory Tract Infections / Q000188:drug therapy; D018805:Sepsis / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: European paediatric hospitals; antibiotic guidelines; childhood infection