Pediatric Hospital Medicine – SHM, AAP, APA

View all recommendations from this society

January 11, 2021

Do not prescribe IV antibiotics for predetermined durations for patients hospitalized with infections such as pyelonephritis, osteomyelitis and complicated pneumonia. Consider early transition to oral antibiotics.

Recent publications have demonstrated that strategies for early transition to oral antibiotics achieve equal or better outcomes for common inpatient infections and are safer than prolonged intravenous antibiotics in children. The use of intravenous lines such as peripherally inserted central catheters, which are often necessary for prolonged intravenous antibiotics, can lead to complications such as thrombosis or line infections. Antibiotic courses with predetermined durations are often not based on high-quality evidence and ignore individual response to treatments, which can vary significantly from patient to patient. Once a patient is able to tolerate them, early transition to oral antibiotics, based on individual patient clinical responses such as defervescence and other symptoms and signs of improvement, are patient and family centered and can improve the value of care for hospitalized children.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

A diverse committee with representatives from the Society of Hospital Medicine’s Pediatrics Special Interest Group, the American Academy of Pediatrics’ Section on Hospital Medicine and the Academic Pediatric Association’s Hospital Medicine Special Interest Group solicited a list of recommendations with specified criteria from colleagues and the various society listservs. Through an iterative process, recommendations were formatted, merged, and presented with an evidence review of publications from the past 10 years supporting each recommendation. From over 100 initial recommendations and through 2 rounds of a modified Delphi process, the highest scoring recommendations were chosen to represent the Pediatric Hospital Medicine Choosing Wisely list. The list was endorsed by the Boards of the Society of Hospital Medicine and the Academic Pediatric Association and peer reviewed by various AAP specialty groups and endorsed by the American Academy of Pediatrics’ Executive Committee.


Keren R, Shah SS, Srivastava R, Rangel S, et al; Pediatric Research in Inpatient Settings Network. Comparative effectiveness of intravenous vs oral antibiotics for post-discharge treatment of acute osteomyelitis in children. JAMA Pediatr. 2015 Feb;169(2):120-8.

Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB et al. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011 Sep;128(3):595-610.

Shah SS, Srivastava R, Wu S, et al; Pediatric Research in Inpatient Settings Network. Intravenous Versus Oral Antibiotics for Post-discharge Treatment of Complicated Pneumonia. Pediatrics. 2016 Dec;138(6).

Schroeder AR, Ralston SL. Intravenous antibiotic durations for common bacterial infections in children: when is enough enough? J Hosp Med. 2014 Sep;9(9):604-9.