Background: Antimicrobial resistance (AMR) causes substantial morbidity and mortality worldwide, with children under five years disproportionately affected. Despite progress in adult antimicrobial stewardship, validated quality indicators (QIs) for antibiotic use in hospitalized children remain limited.

Objective: To review available evidence on QIs for pediatric inpatient antibiotic use, identify evidence gaps, and propose a framework aligned with the WHO AWaRe classification.

Methods: A narrative review was conducted using key reviews, PubMed literature, and grey literature from WHO and ECDC sources.

Results: Ten priority QI domains were identified: empirical prescribing, IV-to-oral switch, microbiological sampling, de-escalation, treatment duration, surgical prophylaxis, AWaRe-concordant prescribing, stewardship infrastructure, neonatal antibiotic use, and documentation.

Conclusion: There is an urgent need for rigorously developed and validated pediatric-specific QIs integrated with the WHO AWaRe framework to support benchmarking and antimicrobial stewardship globally.