{
  "abstract": "Aim To assess the appropriateness of antimicrobial prescribing in a paediatric hospital-at-home (HAH) service, with a focus on intravenous-to-oral switch (IVOS) practices, and to evaluate the potential value of antimicrobial specialist involvement.Method This was a retrospective service evaluation involving all patients aged ≤18 years referred to a HAH service over a six-month period. Clinical data were extracted from hospital records, including demographics, white blood cell count, C-reactive protein, temperature, microbiology results, antimicrobial regimens, and documented reviews. IVOS eligibility was assessed by a clinical pharmacist using a national decision aid. 2 Additionally, a quarter of cases who received intravenous therapy throughout were independently reviewed by a paediatric infectious diseases (PID) consultant, who retrospectively assessed whether oral switch or antibiotic discontinuation would have been appropriate, based on available clinical and microbiological data.Results A total of 139 patients were included, 50% of whom were neonates. The most common indication for antibiotic therapy was suspected sepsis in neonates and fever of unknown origin in older children. Empirical prescribing aligned with national or local guidelines in 88% of cases, and 79% had a documented clinical review within 48 hours. However, only 4% of patients underwent IVOS despite an additional 27% being deemed eligible by pharmacist assessment. Most patients (82%) had negative microbiology results. In a subset of 34 patients reviewed by the PID consultant, 15% were retrospectively assessed as eligible for oral switch, and 74% were deemed suitable for early antibiotic discontinuation. Antimicrobial specialists were not routinely involved in daily HAH care, and formal specialist input was documented in only 16% of cases during prior hospital admission. The findings indicate missed opportunities for timely IVOS or treatment cessation, which could have improved care quality and reduced unnecessary antimicrobial exposure.Conclusion Although initial empirical prescribing was largely guideline-compliant, there was a significant gap in antimicrobial stewardship following referral to the HAH service. Many children received prolonged intravenous antibiotics despite meeting criteria for oral switch or discontinuation. Retrospective review by antimicrobial specialists identified further opportunities for optimisation. These findings underscore the importance of embedding specialist antimicrobial input within paediatric HAH models to promote safe, evidence-based prescribing. Future service models should incorporate routine pharmacist or PID consultant review to enhance stewardship and mitigate risks of resistance and overtreatment. 1 3 4 References Detollenaere J, Van Ingelghem I, Van den Heede K, et al. Systematic literature review on the effectiveness and safety of paediatric hospital-at-home care as a substitute for hospital care. European Journal of Pediatrics 2023;182:2735–2757.UK Health Security Agency. Antimicrobial intravenous-to-oral switch decision aid for paediatrics. UKHSA 2024. https://assets.publishing.service.gov.uk/media/66795c88a7a18c1aa1a00f20/paeds-iv-to-oral-switch-decision-aid-1.pdf (accessed July 2024).Schuts EC, Hulscher MEJL, Mouton JW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. The Lancet Infectious Diseases 2016;16:847–856.Principi N, Esposito S. Antimicrobial stewardship in paediatrics. BMC Infectious Diseases 2016;16:424.",
  "authors": [
    {
      "affiliations": [
        "University College London, UK"
      ],
      "name": "Hassan Othman"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, UK"
      ],
      "name": "Mohammed Abou Daya"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, UK",
        "Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London UK"
      ],
      "name": "Mildred Iro"
    }
  ],
  "title": "SP3 Evaluating antimicrobial stewardship in paediatric hospital-at-home care",
  "uid": "65833099-2462-53d8-a64b-45446a7e922e"
}