Tackling antibiotic resistance during the COVID-19 pandemic is a new challenge for paediatricians.

We welcome Pooja et al's comments on our multinational study from Latin America, which reported high rates of antibiotic prescriptions for children with COVID‐19 or multisystem inflammatory syndrome in children. They reinforce our findings by describing their experience in a U.K. centre, reporting that 390/607 (64.3%) children received antibiotics, which was strikingly higher than our study (24.5%). Importantly, 315/390 (80.7%) children received broad‐spectrum antibiotics.

These findings are extremely relevant for the daily paediatric practice. We are already facing the threat of antimicrobial resistance, and stewardship programmes are needed to improve the quality of prescribing. Our priority is to rationalise our choices and promote the appropriate use of antibiotics. As Pooja et al's state, uncertainty may have led to more antibiotics being prescribed in the early pandemic, despite most children having mild COVID‐19. Other childhood respiratory conditions have drastically reduced, which may have simplified differential diagnoses for most paediatricians. However, some patients received antibiotics because of concomitant illnesses.

We expect that most childhood respiratory diseases will circulate again when social distancing restrictions are eased. As most of the children have not been vaccinated, it will be vital to rationally use antibiotics for those that really need them. The first wave caught us unprepared, but we must anticipate future challenges. Telemedicine services and point‐of‐care tests may allow children to be comprehensively assessed during their first examination. In particular, lung ultrasound has been shown to be sensitive and specific for detecting pneumonia and COVID‐19 and is particularly useful for following up both conditions. Unfortunately, lung ultrasound is rarely used in some paediatric settings, despite being well‐established in paediatric and adult practice.

In our Italian centre, 10/117 (8.5%) children with COVID‐19 have received antibiotics, but five had multisystem inflammatory syndrome in children and one also had an asymptomatic Pseudomonas aeruginosa infection. Only 4/111 (3.6%) received antibiotics for COVID‐19, a much lower percentage than our paper and Pooja et al's In this context, the routine use of lung ultrasound enabled better characterisation of COVID‐19 cases, particularly when the absence of lung consolidation prevented antibiotic use on discharge.

A new pandemic will soon overwhelm paediatrics: multidrug resistant bacteria. We need global awareness and antibiotic stewardship programmes, even during the current pandemic. We fully agree with Pooja et al that antibiotic stewardship strategies must be incorporated into managing all children with COVID‐19.