Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 11;14(10):1011.
doi: 10.3390/antibiotics14101011.

Establishing Priority Pediatric Antimicrobial Stewardship Interventions in the US: Findings from a Delphi Consensus Study

Harry Obeng  1 , Emmanuel Tetteh  2 , Sara Malone  2 , Lauren Walsh  3 , Tyler Walsh  3 , Fernando J Bula-Rudas  4 , Ritu Banerjee  5 , Adam W Brothers  6 , Joshua C Herigon  7 , Katie Namtu  8 , Scott Weissman  9 , Daniel Riggsbee  10 , Jared Olson  11 , Debra Lynn Palazzi  12   13 , Ann Wirtz  14   15 , Matthew Sattler  16 , Jessica Tansmore  3 , Brittany A Rodriguez  17 , Monica Abdelnour  16 , Joshua R Watson  3 , Alison C Tribble  10 , Jessica Gillon  18 , Mari Nakamura  19 , Sarah Jones  19 , Jason G Newland  3   20 , Virginia R McKay  2
Affiliations

Establishing Priority Pediatric Antimicrobial Stewardship Interventions in the US: Findings from a Delphi Consensus Study

Harry Obeng et al. Antibiotics (Basel). .

Abstract

Background/objectives: Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and limited pediatric-specific evidence. This study aimed to identify and prioritize the most critical areas for pediatric ASP intervention development through a structured, multi-round Delphi consensus process with experts in antimicrobial stewardship and infectious diseases.

Method: A four-round modified Delphi process was conducted to identify and prioritize key pediatric ASP interventions. Experts in antimicrobial stewardship and infectious diseases were recruited through an existing clinical trial. Using an iterative survey and in-person discussions, experts provided input on priority areas, which were thematically grouped and refined across rounds. Structured feedback supported real-time refinement and consensus-building.

Results: Twenty experts participated in the process, generating 25 priority items in Round 1 through open-ended responses. These were narrowed to seven key priorities through structured voting and discussion. The final items were clustered into three intersecting themes: Care Settings, Prescriptions, and Strategies. Care Settings focused on high-impact areas such as outpatient clinics and intensive care units, where misuse is common and/or care is complex. The prescriptions theme prioritized shorter durations and narrow-spectrum agents. The strategy theme highlighted the need for outcome-based metrics, improved diagnostic stewardship, and routine tracking of patient outcomes to guide and assess stewardship efforts.

Conclusions: This expert consensus identified key priorities for pediatric ASPs, providing a foundation for future interventions. Findings can be used to inform policy and practice, improving the appropriate use of antimicrobials in pediatrics and combating AMR.

Keywords: antibiotics; antimicrobials; intervention; metrics; stewardship.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Final Consensus- Based Priorities.
Figure 2
Figure 2
Delphi Process Flow Diagram: From Idea Generation to Consensus.
See this image and copyright information in PMC

References

    1. Bamford A., Masini T., Williams P., Sharland M., Gigante V., Dixit D., Sati H., Huttner B., Bin Nisar Y., Cappello B., et al. Tackling the threat of antimicrobial resistance in neonates and children: Outcomes from the first WHO-convened Paediatric Drug Optimisation exercise for antibiotics. Lancet Child Adolesc. Health. 2024;8:456–466. doi: 10.1016/S2352-4642(24)00048-8. - DOI - PubMed
    1. Laxminarayan R., Sridhar D., Blaser M., Wang M., Woolhouse M. Achieving global targets for antimicrobial resistance. Science. 2016;353:874–875. doi: 10.1126/science.aaf9286. - DOI - PubMed
    1. O’Neill J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations (2016) Review on Antimicrobial Resistance. [(accessed on 3 July 2025)]. Available online: https://amr-review.org/sites/default/files/160518_Final paper_with cover....
    1. Barlam T.F., Cosgrove S.E., Abbo L.M., MacDougall C., Schuetz A.N., Septimus E.J., Srinivasan A., Dellit T.H., Falck-Ytter Y.T., Fishman N.O., et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin. Infect. Dis. 2016;62:e51–e77. doi: 10.1093/cid/ciw118. - DOI - PMC - PubMed
    1. Hu Y., Harwell J. Global trends and impact of antimicrobial resistance in paediatric populations: An analysis using WHO AWaRe classification and priority pathogens; Proceedings of the ESCMID Global 2025; Vienna, Austria. 11–15 April 2025.

LinkOut - more resources