Prudent Antimicrobial Prescribing for Paediatrics

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Prudent Antimicrobial Prescribing

This guidance is based on the best available evidence but its application must be modified by:

  • Professional judgement.
  • Recent microbiology results or antibiotic treatment
  • Known carrier status of patients e.g. MRSA, Clostridium difficile toxin and resistant organisms such as ESBL producing coliforms
  • Severity of illness
  • Immunosuppression
  • Age
  • Renal/hepatic function
  • Potential drug interactions
  • Drug allergies and nature of allergic reaction

If in any doubt about the choice of antibiotic, discuss with medical microbiologist.


Antimicrobial Prescribing Principles

  1. Prescribe an antibiotic only when there is likely to be a clear clinical benefit. It is imperative that in order to rationalize therapy, appropriate and timely samples are taken. The results must be actively followed up by medical staff.
  2. Start –stop/ review dates for antimicrobials should be documented on HEPMA to prevent unnecessary prolonged treatment.
  3. The use of antibiotics such as Co-amoxiclav, Ciprofloxacin, Clindamycin and cephalosporins (4C antibiotics) are associated with the acquisition of Clostridium difficile.
  4. Always determine the nature of any allergy and how  genuine it is prior to prescribing antimicrobials. Record allergy status on HEPMA including reaction. True Type 1 hypersensitivity (anaphylaxis) is rare. For penicillin allergy, record whether mild - rash or severe - anaphylaxis.
  5. Avoid the use of Gentamicin for more than three days except in endocarditis or where otherwise clinically indicated. Close monitoring of Gentamicin levels and renal function is compulsory in all cases.
  6. Avoid use of topical antibiotics (especially those agents which are also available as systemic preparations) except for eyes/ears or MRSA eradication
  7. Where empirical therapy has failed seek senior clinical review and check existing microbiology results in the first instance.


 Doxycyline – should not be taken for 2 hours before or after indigestion remedies or medicines containing iron or zinc as the effectiveness can be significantly reduced.



  1. This Model has been adapted to take cognisance of relevant national guidelines and local sensitivity patterns.
  2. Please refer to Children's BNF and Summary of Product Characteristics for further information