{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:33:56Z","timestamp":1791290036484,"version":"4.3.0"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T00:00:00Z","timestamp":1611100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec><jats:title>BACKGROUND\/OBJECTIVE<\/jats:title><jats:p>Pediatric patients hospitalized with bacterial infections often receive intravenous (IV) antibiotics. Early transition to enteral antibiotics can reduce hospital duration, cost, and complications. We aimed to identify opportunities to transition from IV to enteral antibiotics, describe variation of transition among hospitals, and evaluate feasibility of novel stewardship metrics.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This multisite retrospective cohort study used the Pediatric Health Information System to identify pediatric patients hospitalized with pneumonia, neck infection, orbital infection, urinary tract infection (UTI), osteomyelitis, septic arthritis, or skin and soft tissue infection (SSTI) between 2017 and 2018. Opportunity days were defined as days on which patients received both IV antibiotics and enteral medications, suggesting enteral tolerance. Percent opportunity was defined as opportunity days divided by days on any antibiotics. Both outcomes excluded IV antibiotics that have no alternative oral formulation. We evaluated outcomes per infection and antibiotic and assessed across\u2010hospital variation.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>We identified 88,522 aggregate opportunity days in 100,103 hospitalizations. On 57% of the antibiotic days, there was an opportunity to switch patients to enteral therapy, with greatest opportunity days in SSTI, neck infection, and pneumonia encounters, and with clindamycin, ceftriaxone, and ampicillin\u2010sulbactam. Percent opportunity varied by infection (73% in septic arthritis to 40% in pneumonia). There was significant across\u2010hospital variation in percent opportunity for all infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>This multicenter study demonstrated the potential opportunity to transition from IV to enteral therapy in over half of antibiotic days. Opportunity varied by infection, antibiotic, and hospital. Across\u2010hospital variation demonstrated likely missed opportunities for earlier transition and the need to define optimal transition times. Stewardship efforts promoting earlier transition for highly bioavailable antibiotics could reduce healthcare utilization and promote high\u2010value care. We identified feasible stewardship metrics.<\/jats:p><\/jats:sec>","DOI":"10.12788\/jhm.3538","type":"journal-article","created":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T16:30:21Z","timestamp":1612542621000},"page":"70-76","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Opportunities for Stewardship in the Transition From Intravenous to Enteral Antibiotics in Hospitalized Pediatric Patients"],"prefix":"10.1002","volume":"16","author":[{"given":"Jillian M","family":"Cotter","sequence":"first","affiliation":[{"name":"Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Hall","sequence":"additional","affiliation":[{"name":"Children's Hospital Association Lenexa Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya Tang","family":"Girdwood","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R","family":"Stephens","sequence":"additional","affiliation":[{"name":"North Carolina Children's Hospital University of North Carolina School of Medicine Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L","family":"Markham","sequence":"additional","affiliation":[{"name":"Children's Mercy Kansas City University of Missouri Kansas City Kansas City MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C","family":"Gay","sequence":"additional","affiliation":[{"name":"Monroe Carell Children's Hospital at Vanderbilt Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir S","family":"Shah","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2012.1266"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30024-X"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2014.2822"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-1692"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001825"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1086\/510393"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir531"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir363"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.2239"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piy003"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc2388"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1465"},{"issue":"1","key":"e_1_2_6_14_1","first-page":"10","article-title":"Improving the transition of intravenous to enteral antibiotics in pediatric patients with pneumonia or skin and soft tissue infections","volume":"15","author":"Girdwood SCT","year":"2020","journal-title":"J Hosp Med."},{"key":"e_1_2_6_15_1","unstructured":"Core Elements of Hospital Antibiotic Stewardship Programs.Centers for Disease Control and Prevention. 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