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

## TL;DR

This paper reviews how antimicrobial stewardship in pediatric emergency departments can be improved by focusing on four key areas.

## Contribution

The paper provides a focused review of antimicrobial stewardship strategies specifically for the underrepresented pediatric emergency department setting.

## Key findings

- The use of biomarkers and rapid pathogen tests could help reduce unnecessary antibiotic prescriptions in pediatric EDs.
- Blood cultures and watchful waiting may influence prescribing practices in pediatric patients.
- Structured follow-up programs in EDs could improve antimicrobial use in children.

## Abstract

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.