{
  "abstract": "Background Hospital-at-home (HAH) service enables paediatric patients to receive hospital-level care at home. HAH is usually led by nurses without routine input from an antimicrobial specialist. Therefore, evidence-based interventions such as IV-to-oral switch (IVOS) and timely antibiotic discontinuation are often missed.Objectives This study primarily evaluated the appropriateness of antimicrobial prescribing in a paediatric HAH service without infectious disease specialist involvement. Second, assessed the potential value of infectious disease specialist input.Method In this retrospective evaluation, patients aged ≤18 years who were referred to the HAH service between 1 August 2023 and 31 January 2024 and who received IV antibiotics at referral were included. Clinical data were extracted from electronic medical records. Then, IVOS suitability was assessed by a clinical pharmacist using the UK Paediatric Antimicrobial Stewardship IVOS tool. Finally, a random subset of patients was independently reviewed by a paediatric infectious disease consultant.Results Among 139 patients, 50% (70/139) were neonates. Clinical pharmacist assessment identified 27% (38/139) as suitable for IVOS, yet only 4% (6/139) underwent switching. 34 patients were selected as consultant-reviewed cases; oral switch was recommended in 15% (5/34) and discontinuation in 74% (25/34).Conclusion Initial prescribing was largely guideline-concordant; however, IVOS and antibiotic discontinuation opportunities appeared under-utilised in the HAH setting. Also, the independent review suggested that the majority of patients might have been eligible for an earlier switch or cessation of therapy. These findings suggest potential value in integrating specialist antimicrobial input into paediatric HAH care models.",
  "authors": [
    {
      "affiliations": [
        "School of Pharmacy, University College London - Bloomsbury Campus, London, UK",
        "Clinical Pharmacy Department, King Salman Bin Abdulaziz Medical City, Madinah Monawwarah, Saudi Arabia"
      ],
      "name": "Hassan Othman"
    },
    {
      "affiliations": [
        "School of Pharmacy, University College London - Bloomsbury Campus, London, UK"
      ],
      "name": "Pinkie Chambers"
    },
    {
      "affiliations": [
        "Paediatric Pharmacy, Barts Health NHS Trust, London, UK"
      ],
      "name": "Mohammed Abou Daya"
    },
    {
      "affiliations": [
        "Paediatric Infectious Diseases and Immunology, Barts Health NHS Trust, London, UK",
        "Blizzard Institute, Queen Mary University of London, London, UK"
      ],
      "name": "Mildred A Iro"
    }
  ],
  "title": "Antimicrobial stewardship in paediatric hospital-at-home care models: implementing IV-to-oral switch and the value of antimicrobial specialists",
  "uid": "60e00356-0d93-5ee1-9f19-c586221359b9"
}