Table 1.
Nonredundant list of items to specify inappropriate therapy as adjudicated by the expert panelists in the point-prevalence study conducted among 30 pediatric cancer centers in Germany and Austria, 2020-2021.
| Code | Item | Notes |
| 1 | Unnecessary therapy (1) | (Prolonged) antibacterial therapy in patients with respiratory tract infection with viral detection |
| 2 | Unnecessary therapy (2) | Prolonged antibacterial therapy (>72 h) in newly diagnosed ALLa with fever without signs of a bacterial infection |
| 3 | Inappropriate therapy (1) | No deescalation when pathogen is known |
| 4 | Inappropriate therapy (2) | Early escalation (before 48h) without clinical deterioration |
| 5 | Dosage | >20% above or below the range for an antimicrobial agent as indicated in the internal guideline |
| 6 | Lack of Pseudomonas aeruginosa coverage | —b |
| 7 | Empirical combination therapy | Upfront combination therapy in febrile neutropenia without being founded in the local guideline |
| 8 | Primary empirical treatment with meropenem or imipenem | In patients without known colonization with multidrug-resistant organisms |
| 9 | Primary empirical treatment with vancomycin or teicoplanin | Exceptions: AMLc induction therapy with high-dose cytarabine; extensive skin/soft tissue infection; central line–associated infection; known colonization with MRSAd |
| 10 | Double coverage (1) | Piperacillin/tazobactam or meropenem, each combined with metronidazole (exception: systemic infection in addition to Clostridioides difficile enterocolitis) |
| 11 | Double coverage (2) | Meropenem plus aminoglycoside (exceptions: multidrug-resistant P. aeruginosa) |
| 12 | C. difficile (1) | Intravenous treatment with vancomycin or teicoplanin in C. difficile–related enterocolitis |
| 13 | C. difficile (2) | Primary oral treatment with metronidazole instead of vancomycin |
| 14 | Surgical antibiotic prophylaxis (1) | >24h without a comprehensible rationale |
| 15 | Surgical antibiotic prophylaxis (2) | Drugs of choice: cefazolin, cefuroxime, or ampicillin-sulbactam; in penicillin allergy: clindamycin |
| 16 | Bug-drug mismatch | — |
| 17 | Aminoglycosides (1) | Application twice or thrice per day instead of once |
| 18 | Aminoglycosides (2) | No TDMe performed |
| 19 | Aminoglycosides (3) | Contraindications (eg, renal insufficiency) |
| 20 | Vancomycin | No TDM performed |
| 21 | Linezolid | Twice per day instead of thrice per day in children ≤12 years of age |
| 22 | Lack of dosage adjustment in renal insufficiency (creatinine clearance <50 mL·min–1·1.72 m–2) | for example: ceftazidime, cefepime, ciprofloxacin, imipenem/cilastatin, meropenem, metronidazole, vancomycin |
| 23 | Other | Indicated in an open-text format |
aALL: acute lymphocytic leukemia.
bNot applicable.
cAML: acute myeloid leukemia.
dMRSA: methicillin-resistant Staphylococcus aureus.
eTDM: therapeutic drug monitoring.