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Original article
Variation in paediatric hospital antibiotic guidelines in Europe
  1. N Spyridis1,
  2. G Syridou1,
  3. H Goossens2,
  4. A Versporten2,
  5. J Kopsidas3,
  6. G Kourlaba3,
  7. J Bielicki4,
  8. N Drapier2,
  9. T Zaoutis3,5,
  10. M Tsolia1,
  11. M Sharland4
  12. ARPEC Project Group Members
    1. 1Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece
    2. 2Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
    3. 3Stavros Niarchos Foundation—Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece
    4. 4Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
    5. 5The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
    1. Correspondence to Dr Nikos Spyridis Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, National & Kapodistrian University of Athens, School of Medicine, Thivon & Levadias, Athens 11527, Greece; nspyridis{at}; nspyridis{at}


    Objective To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics.

    Design Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children.

    Results 84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy.

    Conclusions Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.

    • antibiotic guidelines
    • childhood infection
    • European paediatric hospitals

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