Multinational consensus antimicrobial stewardship recommendations for children managed in hospital settings.

Children are entitled to receive antibiotic therapy that is based on evidence and best practice, but might be overlooked in hospital programmes designed to achieve antimicrobial stewardship [AMS]. This failure to include children could be because children make up small proportion of patients in most hospitals, and are cared for by specialised paediatric staff. We reviewed the evidence and consulted experts in three global regions to develop ten recommendations for good-practice in hospital AMS programmes for children. We performed a review of scientific research, published between Jan 1, 2007, and Oct 17, 2019, concerning AMS, and formed a multinational expert group comprising members from the USA, Canada, the UK, Belgium, Switzerland, Australia, and Aotearoa New Zealand to develop the recommendations. These recommendations aim to help health-care workers who care for children in these regions to deliver best-practice care. We surveyed health-care workers with expertise in antibiotic therapy for children across these regions, and found that the recommendations were considered both very important and generally feasible. These recommendations should be implemented in hospitals to improve antibiotic therapy for children and to stimulate research into future improvements in care.

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Declaration of interests BM has received grants from the Sydney Children's Hospital Foundation and the National Health and Medical Research Council; holds an unpaid role on data safety monitoring board of the Pragmatic Adaptive Trial for Respiratory Infections in Children trial; and was a Board Director of the Australasian Society for Infectious Diseases from June, 2018–June 2022. JN has received a grant from Agency for Healthcare Research and Quality. JB has received grants from the European & Developing Countries Clinical Trials Partnership, Horizon 2000, Swiss National Science Foundation, National Institute for Health and Care Research, and Wellcome Trust; has received consulting fees from Shionogi and Sandoz, in addition to paid speaking events on behalf of Pfizer, Sandoz, and Bayer; and has also held unpaid positions on advisory boards for independent data monitoring committees for the Boost–EBOC trial, the Avenir trial, and the Lakana trial, and the trial steering committee for the cASPerCF trial, in addition to unpaid roles for SwissPedNet and the Penta Foundation. PDC has received grants from the Research Foundation–Flanders and the Belgian Healthcare Knowledge Centre, and has received payments for speaking engagements at the Congress of the European Society for Development, Perinatal, and Pediatric Pharmacology. KT has received payments for consultation from Avir Pharma and Wolter Kluwer. RFH declares a position as Committee Chair of the Pediatric Infectious Diseases Society. ACT has received grants from the Agency for Healthcare Research and Quality and the Cystic Fibrosis Foundation; has received payment from PBS for consultation and from the Pediatric Infectious Diseases Society for lectures; and is a committee chair of the Paediatric Infectious Diseases Society. All other authors declare no competing interests.