570 - Barriers and Strategies to Promote Oral over Intravenous Antibiotics for Children Hospitalized with Pneumonia: Insights from Nurses, Clinicians, and Caregivers

Publication Number: 2555.570

Jillian Cotter, University of Colorado School of Medicine, Aurora, CO, United States; Catia Chavez, University of Colorado School of Medicine, Aurora, CO, United States; Steven Lockhart, University of Colorado, Anschutz, Aurora, CO, United States; Lilliam Ambroggio, Children's Hospital Colorado, Aurora, CO, United States; Allison Kempe, University of Colorado AMC and ACCORDS, denver, CO, United States; Christina Studts, University of Colorado School of Medicine, Aurora, CO, United States; Brooke Dorsey, University of Colorado School of Medicine, Aurora, CO, United States

Background: Despite evidence supporting oral antibiotics as initial treatment for children hospitalized with pneumonia and benefits of orals including reduced pain, costs, and length of stay, most children still receive initial IV antibiotics.

Objective: To describe caregivers', nurses', and clinicians' perspectives on the barriers, facilitators, and strategies to increase oral antibiotics as initial treatment for children hospitalized with pneumonia.

Design/Methods: We conducted a qualitative study using semi-structured interviews and purposing sampling. We included (1) caregivers of non-medically complex, non-critically ill children hospitalized with pneumonia within the previous 30 days, (2) pediatric nurses and (3) pediatric clinicians in the emergency department (ED) and inpatient settings at a children's hospital (12/2024-6/2025). Interviews were conducted via Zoom or telephone, audio-recorded, professionally transcribed, and analyzed by two investigators using rapid qualitative analysis until thematic saturation was reached.

Results: We interviewed 10 caregivers, 10 nurses, and 12 clinicians (Table 1). Six themes emerged (Table 2): (1) Patient factors, such as oral intolerance, antibiotic allergies, and existing PIV, and caregiver expectations, based on perceived IV superiority, can be barriers to initial oral antibiotics. (2) Medical team beliefs, norms, and hospital systems create barriers to oral antibiotic use. These include ingrained IV norms, perception of IV antibiotics as more effective, and IV antibiotic momentum. (3) Most caregivers support oral antibiotics after education. Caregivers often prefer oral antibiotics; those with initial IV preference usually supportive of orals after clinician counseling. (4) Shared commitment to patient-centered care drives institutional and clinical support for oral-first antibiotic strategies. This is rooted in evidence-based culture, stewardship focus, and confidence in orals, with perceived benefits for patient experience, safety, discharge, nursing workflow, and home medication success. (5) Education and engagement, with clinicians, nurses, and caregivers, can build trust in oral therapy. (6) System-level strategies - leveraging nurses and pharmacists, decision support tools, and improved access to oral alternatives to amoxicillin - can also promote oral use.

Conclusion(s): Increasing oral antibiotic use hinges on addressing both perceptions and processes. Education, stewardship-driven culture, and operational enablers can transform practice, improving outcomes for children and reducing healthcare burden.

Table 1. Participant Characteristics


Table 2. Themes, Sub-themes, and Quotes
ED, emergency department; IP, inpatient; PIV, peripheral intravenous catheter