vii Introduction Welcome to the 27th edition of Nelson’s Pediatric Antimicrobial Therapy, a collaboration among our editors, representing experts in clinical pediatric infectious diseases and pharmacology, our very own pediatrician smartphone app code writer, and the American Academy of Pediatrics (AAP)! For this edition, we have made the first changes in the order of the printed chapters in the book in 40 years. We start off with the most clinically relevant chapters: infections in children (Chapter 1) and infections in neonates (Chapter 2). We then present the “edu- cational” chapters that provide insight into why the editors select specific drugs for spe- cific infections, with John Nelson’s original approach to choosing among antibiotics now fully extended to antifungals, antivirals, and antiparasitic agents. Also new for this year are chapters that you have been requesting. First is “Approach to Antibiotic Allergies,” written by Chris Cannavino (a pediatric infectious disease specialist, as well as a pediatric hospitalist by training) and based on his recent presentation at the AAP National Conference and Exhibition. Very practical advice for all those clinicians whose parents believe that a rash while taking an antibiotic is proof of allergy. Second, JB Cantey and I have written a chapter called “Antibiotic Stewardship.” JB is recognized as an international expert in neonatal antimicrobial stewardship, which is supported by his clinical research. Our approach is to hit hard if you need to, then back off as quickly as you can, stopping at the earliest possible moment these are concepts that we all believe in, designed to limit antibiotic resistance, toxicity, and effect on a child’s microbiome. The contributing editors, all very active in clinical work, have updates in their sections with important new recommendations based on currently published data, guidelines, and their clinical experience. We continue to share updated references as evidence to support our recommendations, for those who wish to see the actual clinical trial and in vitro data. The Nelson’s app has continued to evolve under Dr Howard Smart’s direction (he uses the app in his pediatric practice), and I must admit, it is now easier for me to find infor- mation on the app than in my print book. Howard keeps improving the app, so if any- one has some thoughts on how we can make it even easier for you to find information, please just let us know at Peter Lynch, our AAP digital product partner, has been very supportive of the app, and we are currently trying to get the app into some of the most often used electronic medical records so that you can look up infections, antimicrobials, and doses while writing in a child’s electronic chart. As new important information becomes available (eg, new drugs approved), we will share that information with Howard Smart to add to the app, which is periodically “pushed out” to the registered users. In addition, for those who have the print version of the book, Peter Lynch has created a mechanism for us to post new information online at We always appreciate the talent and advice of our collaborators and colleagues who take the time to see if what we are sharing makes sense. Dr John van den Anker, a neonatolo- gist and pharmacologist, has again provided excellent suggestions to us for our neonatal ch00-Nelson-2021_FM_i-xii.indd 7 11/24/20 9:51 AM
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