The American Academy of Pediatrics (AAP), as part of the Choosing Wisely® campaign, wants to protect hospitalized children from the effects of antibiotic resistance by providing a list of recommendations to serve as a starting point of conversation for physicians and patients. The five items that physicians and patients should question on the Choosing Wisely List of Antibiotic Stewardship in Hospitalized Children are:

1. Before antibiotics are prescribed, testing of the patient’s blood, urine and other appropriate cultures should be undertaken to confirm suspected invasive bacterial infection.
2. During surgery, the dose and timing of antibiotics to prevent infection are important for optimal effect, and should not be used indiscriminately.
3. Ampicillin is the first choice of treatment for children hospitalized with community-acquired pneumonia who are otherwise healthy and immunized. Broader-spectrum antibiotics, such as cephalosporins, have been shown to contribute to antibiotic resistance and are often unnecessary.
4. Antibiotics such as vancomycin or carbapenems should be avoided unless a child is known to have a specific risk for pathogens that are resistant to other antibiotics.
5. Avoid using prolonged courses of IV antibiotics. For most infections, children respond well to orally administered antibiotics after a brief course of intravenous therapy. Peripherally inserted central catheters, used to facilitate prolonged courses of IV antibiotics, often result in complications.