Antibiotic Prescribing Patterns and Stewardship Opportunities in Pediatric Facial Trauma: A Five-Year Retrospective Analysis.

Objectives: To assess antibiotic prescribing practices in pediatric facial trauma at a tertiary academic center, examine their association with infection outcomes, and identify stewardship opportunities to inform future larger-scale evaluation of antibiotic use in pediatric facial fractures. Methods: This retrospective chart review included pediatric patients (< 18 years) presenting via trauma activation with facial trauma to a tertiary academic medical system over 5 years. Patients were identified through the institutional data warehouse. Data collected included demographics, injury patterns, antibiotic prescribing details (route, duration, timing), surgical interventions, and clinical outcomes. The primary outcome was infection development; secondary outcomes included antibiotic-related complications. Descriptive statistics characterized prescribing patterns, and univariate tests evaluated associations between antibiotic use and outcomes. Multivariable modeling was not performed due to only two infection events. Statistical significance was set at Results: Among 223 pediatric patients with facial fractures, the infection rate was low (< 1%). Despite this, 46.2% received antibiotics, though only 32.3% received systemic therapy. Among treated patients, 68.9% received courses exceeding 5 days (median 8 days), and over 70% received intravenous antibiotics. Surgical intervention was most strongly associated with antibiotic use, with surgical patients receiving antibiotics significantly more often than non-surgical patients. Open fractures were associated with higher utilization and longer durations compared with closed fractures. Both documented infections occurred in antibiotic recipients, though this association was not statistically significant. Notably, 51% of antibiotic recipients were candidates for shorter courses or oral conversion. Conclusion: These findings suggest potential antibiotic overutilization and highlight substantial opportunities to optimize stewardship in pediatric facial trauma, including limiting prophylactic duration, favoring oral therapy when appropriate, and better targeting antibiotics to high-risk patients. Prospective, multicenter studies are needed to guide evidence-based guideline development. Level of Evidence: Level IV.