title: Inpatient Antimicrobial Stewardship in Pediatrics: A Systematic Review.
abstract: BACKGROUND
  The clinical and economic outcomes associated with pediatric antimicrobial stewardship programs (ASPs) and other supplemental antimicrobial stewardship (AS) interventions have not been well described or reviewed.
  
  
  METHODS
  We performed a systematic review using PubMed to identify studies with any of the following terms in the title or abstract: "antimicrobial stewardship," "antimicrobial control," "antibiotic control," or "antibiotic stewardship." Studies were further limited to inpatient studies in the United States that contained the terms: "child," "children," "pediatric*" ("*" includes all terms with the same stem), "paediatric,*" "newborn," "infant," or "neonat,*" in the title or abstract. Clinical and economic outcomes from each relevant study were summarized.
  
  
  RESULTS
  Nine original studies reported outcomes related to formal pediatric ASPs. An additional 8 studies focused on specific AS interventions; 3 on management of community-acquired pneumonia, 2 on vancomycin-specific initiatives, and 1 each on clinical support, antibiotic restriction, and antibiotic rotation. Reported outcomes include decreases in antimicrobial utilization (11 studies), prescribing errors (3 studies), and drug costs (3 studies). Five studies assessed the potential adverse effects of AS interventions on patient safety and found none. Data to support an association between pediatric AS interventions and antimicrobial resistance are limited.
  
  
  CONCLUSIONS
  A small number of pediatric studies evaluating ASPs or other AS strategies have been published. These studies demonstrate reductions in antimicrobial utilization, cost, and prescribing errors with no apparent negative impact on patient safety. Although the studies are promising, the current evidence base is limited. Additional studies focusing on the appropriateness and outcomes of antimicrobial prescribing practices as well as more formalized economic evaluations are needed.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D016527:Drug Costs; D004363:Drug Utilization; D006801:Humans; D007297:Inpatients; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D014481:United States; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D014640:Vancomycin
keywords: antimicrobial stewardship; systematic review