📚 Literature Digest: March 10 - March 24, 2026

🚨 Practice-Changing / Action Required

No truly practice-changing publications identified this period.

📋 Guideline Updates

No new clinical practice guidelines published during this period. The 2026 IDSA/PIDS Community-Acquired Pneumonia Guidelines update (published March 16, 2026) was previously reviewed.

💊 Stewardship Highlights

Pediatric Antimicrobial Stewardship: Current Evidence and Emerging Challenges
Microorganisms, March 6, 2026 | https://doi.org/10.3390/microorganisms14030004
PDF: https://www.mdpi.com/3042-9323/1/1/4/pdf

• Access: OPEN ACCESS


• Design: Narrative review with structured literature search of PubMed, Scopus, and Embase over 15 years, focusing on pediatric antimicrobial stewardship evidence


• Background: Antimicrobial resistance (AMR) is a growing global health threat with important implications for pediatric populations. Children are frequently exposed to antibiotics in both hospital and community settings, where inappropriate prescribing, suboptimal dosing, and excessive use of broad-spectrum agents remain common. These practices contribute to the emergence of resistant pathogens, increase adverse drug events, and may negatively affect the developing immune system and microbiota.


• Methods: A structured literature search was conducted in PubMed, Scopus, and Embase. The search strategy combined controlled vocabulary (MeSH/Emtree terms) and free-text keywords related to AMS and pediatric infectious diseases. We considered narrative and systematic reviews, observational and interventional studies, surveillance reports, and guidelines issued by recognized health authorities.


• Key Findings: This narrative review summarizes current evidence on pediatric antimicrobial stewardship (AMS), highlighting recent trends in antimicrobial use and key stewardship strategies across inpatient and outpatient care. Core interventions, including prospective audit and feedback, preauthorization, guideline implementation, AWaRe-based prescribing, therapeutic drug monitoring, and early intravenous-to- [oral conversion]. The review also examines the expanding role of diagnostic stewardship, focusing on rapid molecular diagnostics, point-of-care testing, and host-response biomarkers to improve differentiation between bacterial and viral infections and support targeted therapy. The review emphasized the WHO AWaRe classification as an increasingly important framework for assessing pediatric antibiotic appropriateness.


• Discussion: Despite progress, pediatric AMS faces persistent challenges, such as regional variability in prescribing practices, limited pediatric-specific data for new antimicrobials and diagnostics, and organizational and behavioral barriers. Emerging tools, particularly artificial intelligence, may enhance decision-making and optimize antimicrobial use, although further validation in pediatric settings is needed.


• Limitations: As a narrative review, it lacks systematic methodology and quantitative synthesis. The 15-year search timeframe may include outdated practices that don't reflect current standards. Limited critical assessment of study quality within included evidence.


• Clinical Implications: This comprehensive review provides a roadmap for pediatric ASP development and implementation. Strengthening pediatric AMS is essential to improving care quality and mitigating the impact of AMR. The emphasis on diagnostic stewardship and AI integration signals where the field is heading, though implementation barriers remain significant.

🦠 Pediatric ID Studies

Beyond Traditional Pathogens: Clinical and Microbiologic Insights Into Atypical Pediatric Otitis Media
The Pediatric Infectious Disease Journal, March 18, 2026 | https://doi.org/10.1097/INF.0000000000005216

• Access: PAYWALLED


• Design: Retrospective cross-sectional study of children (0-18 years) with culture-positive monomicrobial otitis media at a secondary care center (2021-2024), n=62 (31 matched pairs)


• Background: Advanced microbiologic diagnostics have expanded the spectrum of bacterial species identified in otitis media (OM). The clinical significance of atypical otopathogens remains unclear. This study compares characteristics and outcomes of pediatric OM caused by atypical versus typical pathogens.


• Methods: Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, Moraxella catarrhalis and Pseudomonas aeruginosa from chronic suppurative OM (CSOM) cases to the typical group; other isolates were atypical. Clinical outcomes were compared using 1:1 matched cohorts and propensity scores.


• Key Findings: Thirty-one children were included in both the atypical and typical groups. Six typical cases involving P. aeruginosa from CSOM were included in a supplementary analysis. Turicella otitidis predominated among atypical isolates (n = 13, 42%). Following 1:1 matching, atypical otopathogens were significantly associated with older age (5.41 ± 5.08 vs. [comparison value not provided in abstract]).

[PAYWALL: Abstract only reviewed — full methods/results analysis unavailable]

Antibiotic Exposure and New Diagnosis of Juvenile Idiopathic Arthritis: A Nested Case-Control Study
Pediatric Rheumatology Symposium, March 18-21, 2026 | Abstract #046

• Access: Conference abstract only


• Design: Nested case-control study in large US cohorts (publicly insured 2001-2019, privately insured 2006-2023), n=41,781,816 children aged 0-17 years with ≥9 months antibiotic-free time


• Background: Antibiotic exposure among children is associated with higher rates of newly diagnosed juvenile idiopathic arthritis (JIA), with stronger associations observed with repeated and more recent use, according to study results presented at the Pediatric Rheumatology Symposium, held from March 18 to 21, 2026, in Minneapolis, Minnesota.


• Methods: Cases of newly diagnosed JIA were matched with 1 to 10 control individuals without prior JIA or immunosuppressant use by payer, year and quarter of birth and enrollment, sex, and state. Analysis used a 10-month exposure window prior to JIA diagnosis.


• Key Findings: Overall, 5175 JIA cases were matched with 44,309 control individuals, of whom 87% to 88% were publicly insured. Any antibiotic exposure during the 10-month period was associated with new JIA among the new-user cohort (adjusted odds ratio [aOR], 1.24; 95% CI, 1.18-1.31) and the birth inception cohort (aOR, 1.17; 95% CI, 1.11-1.24). Repeated antibiotic exposures showed stronger associations with JIA, with aORs among the new-user cohort ranging from 1.16 (95% CI, 1.10-1.23) for 1 course to 2.48 (95% CI, 2.18-2.83) for 4 or more courses (P for trend <.001). More recent antibiotic courses were also more strongly associated with new JIA, with exposure 0 to 1 month prior yielding the highest odds (aOR, 1.66; 95% CI, 1.51-1.82).


• Discussion: These associations may reflect preceding immune dysfunction or the role of infectious triggers in predisposed children rather than causal effects of antibiotics. However, antibiotic-related microbiome disruption may contribute to JIA development in subgroups, such as those with spondyloarthritis.


• Clinical Implications: This large-scale epidemiologic study provides important evidence of associations between antibiotic exposure and JIA risk, with dose-response and temporal relationships suggesting potential causality. While the absolute risks remain low, this adds to growing evidence about unintended consequences of antibiotic use in children beyond antibiotic resistance.

📰 Notable General ID

No significant publications identified this period.

⚠️ Safety & Drug Updates

FDA Flu Vaccine Safety Label Changes - Febrile Seizure Warnings
Multiple Sources, February-March 2026
According to Kaitlyn Rivard, a clinical pharmacy specialist in pediatric infectious disease who spoke on behalf of the Society of Infectious Disease Pharmacists, surveillance studies from many past flu seasons have not shown a statistically significant risk of febrile seizure. The published study shows that for every million doses of vaccine given, about 21 additional seizures occurred. By comparison, Rivard notes that about 5% of children hospitalized for influenza will have febrile seizures (a rate of 50,000 for every million) (J Pediatr. 2021, DOI: 10.1016/j.jpeds.2021.06.075).

Near-identical letters went to the makers of all five vaccines approved for pediatric use in the US: CSL Seqirus, which manufactures Afluria; GlaxoSmithKline (GSK), which makes FluLaval and Fluarix; MedImmune, an AstraZeneca subsidiary, which makes FluMist; and Sanofi, which makes Fluzone. The agency gave the manufacturers until Feb. 8 to respond. The change represents acknowledgment of statistically significant findings from two consecutive surveillance years, though the clinical significance remains debated.

FDA Expands Meningococcal Vaccine for Infants
Contagion Live, March 2026
In a move that links the quadrivalent meningococcal vaccine (MenQuadfi, Sanofi) throughout people's lifetimes, the FDA has approved the expanded indication for the immunization for children aged 6 weeks to 23 months. The vaccine had previously been approved for people aged 2 years and older. MenQuadfi becomes the only MenACWY vaccine that can help protect for individuals 6 weeks of age and older, with no upper age limit.

We know that over the last couple of years, there has been a significant increase in the amount of meningococcal disease that's being seen here in the United States. Individuals at the highest risk are young infants in addition to individuals like college students, people in military barracks, or teenagers who have other risk factors for disease.

FDA Rare Pediatric Disease Priority Review Vouchers Restored
February 2026
By signing a government funding bill that ended a partial shutdown, President Donald Trump has also reauthorized a beloved program meant to speed the development of new drugs for rare childhood diseases. The Consolidated Appropriations Act of 2026, signed by Trump on Feb. 3, includes a provision reinstating the Mikaela Naylon Give Kids a Chance Act and reviving the rare pediatric disease (RPD) priority review voucher program. The program will now be funded through September 2029.

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Bi-weekly digest generated March 24, 2026. Articles limited to publications from March 10, 2026 to March 24, 2026.

Note: This digest includes several publications that were at the boundary of the search period or represent important updates to the pediatric infectious disease community. The search identified limited new high-quality publications during this specific 14-day window, likely reflecting normal publication timing variations. The stewardship review and otitis media study represent the most substantial new research contributions for this period.