Paediatric outpatient parenteral antimicrobial therapy (pOPAT) refers to the administration of intravenous antibiotics to children outside the hospital environment, most commonly in the patient's home. According to the reviewed literature, most children who subsequently receive pOPAT first present to hospital and begin antibiotic therapy as inpatients before transitioning to outpatient care. The service model therefore spans inpatient initiation and community-based continuation of intravenous antimicrobial treatment.
This outpatient pathway is increasingly used to manage common paediatric infections while reducing inpatient length of stay, but it shifts responsibility for aspects of antimicrobial management from a wholly hospital-based team to community-based clinicians, families, and carers.
As provision of pOPAT grows, healthcare organisations must extend attention to antimicrobial stewardship (AMS) beyond the hospital. AMS aims to optimise antimicrobial use to achieve best clinical outcomes while minimising unintended consequences such as adverse events and antimicrobial resistance. The literature review emphasises the need to consider stewardship interventions within outpatient settings where prescribing decisions, monitoring, and duration of therapy continue to influence resistance pressures and patient safety.
Outpatient stewardship presents distinct challenges compared with inpatient AMS: different prescribers, variable access to diagnostics and specialist advice, reliance on community nursing and family administration/support, and the logistical complexities of delivering intravenous therapy outside acute care. These factors make explicit AMS processes and clear governance important when pOPAT services are delivered in the community.
The author highlights a notable lack of research focused specifically on the role of children's nurses in pOPAT delivery and outpatient AMS. While pOPAT models include nursing responsibilities for administration, monitoring, and education, the literature does not adequately describe how children's nurses contribute to or could influence antimicrobial decision-making, stewardship activities, or escalation and review of therapy.
This evidence gap includes limited reporting on nurses' confidence, training needs, authority to query or challenge prescribing, and the structures that support nurse-led stewardship behaviours in community paediatric services. The review therefore identifies an opportunity for research to define and evaluate nursing roles, competencies, and interventions that support appropriate antimicrobial use in pOPAT.
For children's nurses working in community settings, the review outlines several practical implications:
Knowledge and awareness: Nurses involved in pOPAT should understand the principles of AMS, common stewardship interventions, and the importance of appropriate antimicrobial selection, dosing, monitoring, and duration.
Clinical vigilance and monitoring: As frontline providers in home-based intravenous antibiotic delivery, children's nurses play a key role in monitoring clinical response, recognising adverse events, and ensuring timely review of ongoing antimicrobial therapy.
Communication and escalation: Nurses need the confidence and clear pathways to question or escalate prescribing decisions when concerns arise about indication, duration, or safety of therapy.
Education and support for families: Providing families with information about the purpose of therapy, expected course, signs of complications, and adherence supports appropriate use and early detection of problems.
Integration with stewardship governance: Community nursing teams should be included in organisational AMS planning for pOPAT services to ensure consistent documentation, review schedules, and access to specialist advice when necessary.
The review stresses that promoting nurse involvement in these areas could improve patient outcomes and contribute to reducing the development and spread of antimicrobial resistance.
The author recommends that as outpatient antimicrobial services expand, healthcare organisations should explicitly incorporate AMS principles into pOPAT service design. Key priorities identified from the literature include:
Embedding stewardship processes into outpatient pathways so that review, de-escalation, and stop dates are clearly documented and actioned.
Enhancing education for children's nurses on AMS concepts and on practical aspects of pOPAT management to build confidence in discussing prescribing decisions.
Supporting mechanisms for nurses to raise concerns or recommend review of antimicrobial therapy, with defined escalation routes and multidisciplinary collaboration.
Conducting research to define the role of children's nurses in pOPAT and AMS, evaluate the impact of nurse-facing interventions on prescribing and outcomes, and identify barriers to effective nurse engagement in stewardship activities.
The review does not provide specific intervention trial results or numeric outcome data; it summarises the literature's thematic findings and highlights areas needing further investigation.
The author declares no conflicts of interest. The review appears in Nurs Child Young People (online ahead of print) with DOI 10.7748/ncyp.2026.e1593 and PubMed ID (PMID) 42764830. The article underscores the need to promote children's nurses' involvement in pOPAT and outpatient AMS to improve clinical outcomes and mitigate antimicrobial resistance.