Development and maintenance of consensus recommendations on pediatric outpatient antibiotic therapy in Germany: a framework for rational use
Authors: Soler Wenglein Janina , Simon Arne , Berner Reinhard , Brockmeyer Holger , Forster Johannes , Hamelmann Eckard , Klein Wolfgang , Liese Johannes , Neubert Jennifer , Pfeil Johannes , Renk Hanna , Tenenbaum Tobias , Toepfner Nicole ,   further ABSaP Working Group members, Armann Jakob , Boethig Chris , Dogan Oezguer , Huebner Johannes , Lange Jost , Lenz Thomas , Lueder Steffen , Moeller Gerhard , Parlowsky Thomas , Prusseit Julia , Reinke Stefan , Schober Tilmann , Trapp Stefan , von Both Ulrich , Yussif Anne-Sophie , Hufnagel Markus , Tillmann Roland 
Published: January 2025

Abstract
In pediatric outpatient care, overuse and misuse of antibiotics is linked to a high risk of adverse events and increased antibiotic resistance. In 2019, building upon the work of the Antibiotic Therapy in Bielefeld (AnTiB) project (founded in 2016), a collaboration among the AnTiB, the German Society for Pediatric Infectious Diseases (DGPI), and the Professional Association of Outpatient Pediatricians and Adolescent Physicians (BVKJ) was established to develop consensus recommendations for antibiotic therapy in pediatric outpatient settings in Germany. This working group became the Antibiotic Stewardship in Outpatient Pediatrics (ABSaP). ABSaP institutes recommendations for antibiotic use in outpatient pediatric settings in Germany and updates them regularly. The ABSaP guidelines recommend restrictive, targeted, evidence-based prescription practices for antibiotics used to treat common infections among pediatric outpatients. This expert-driven, pragmatic, best-practice guidance is designed to be a living document. ABSaP’s most recent update was published in March 2024. The recommendations aim to guide and standardize rational antibiotics use by emphasizing the importance of avoiding unnecessary prescriptions, while also promoting the application of narrow-spectrum antibiotics, short-duration therapy, and watchful waiting, when treating mild, self-limiting infections in children without significant risk factors.

Conclusions: ABSaP’s guidelines may provide a model for others, as well as offer a basis for discussing practical, effective antibiotic stewardship (ABS) measures in pediatric primary care. An international, expert consensus on ABS for pediatric outpatients could help promote a culture of responsible antibiotic use, improve prescribing safety, and contribute to broader ABS efforts.

What is Known:• Overuse and misuse of antibiotics are associated with adverse events and increased antibiotic resistance, prompting the need for effective antibiotic stewardship initiatives.• The Antibiotic Stewardship in Outpatient Pediatrics (ABSaP) working group was established to develop and regularly update evidence-based best practice recommendations for the targeted and restrictive use of antibiotics in pediatric outpatient settings in Germany.

What is New:• The most recent update of the ABSaP guidelines was published in March 2024, emphasizing the importance of narrow-spectrum antibiotics, short-duration therapy, and watchful waiting for mild infections, aiming to standardize rational antibiotic use in children.• The ABSaP guidelines have become widely accepted in Germany and are now being translated into English to foster international dialogue and collaboration on antibiotic stewardship in pediatric primary care, potentially serving as a model for similar initiatives in other countries.