Decreasing antibiotics for acute otitis media and community acquired pneumonia, with Elysha Pifko, MD

At the 2025 Pediatric Academic Societies (PAS) meeting in Honolulu, Hawaii, Elysha Pifko, MD, presented results of a quality improvement (QI) project aimed at reducing antibiotic duration for acute otitis media (AOM) and community-acquired pneumonia (CAP) across a large pediatric health care system. The initiative, titled “Decreasing Ambulatory Antibiotic Treatment Duration for Acute Otitis Media and Community Acquired Pneumonia within a Pediatric Integrated Healthcare System,” was implemented across 2 emergency departments (ED), 67 primary care (PC), and 3 urgent care (UC) sites in Delaware, Pennsylvania, and Florida.

“This was a quality improvement project that we have been working on for quite some time, and I've had really remarkable success,” said Pifko, assistant professor of Pediatrics at Sidney Kimmel Medical College and Nemours Alfred I. duPont Hospital for Children. “This project is one of the first projects that really is enterprise-wide, meaning it's involving multiple different clinical care settings.”

The QI effort began as a pilot in the ED with an amoxicillin order panel for AOM. Following its success, a multidisciplinary team—including infectious disease specialists, pharmacists, nurses, and physicians—developed clinical pathways and order sets for both AOM and CAP. These tools standardized antibiotic choice and duration, guided by national recommendations favoring shorter treatment courses.

“We actually did in-person education for about 700 different providers… educating people about the order panels, order sets, the recommendations for these antibiotics and really [asked] 'what were our goals for the project,'” Pifko said.

From October 2023 to September 2024, data from 26,896 patients showed an increase in appropriate antibiotic duration from 51% to 83%, with no rise in repeat antibiotic prescriptions within 7 to 30 days—supporting the clinical effectiveness of shorter courses. Specifically, adherence rose from 59% to 81% for AOM and 39% to 72% for CAP. Average prescription durations decreased from 8.5 to 6.8 days for AOM and 7.6 to 6.0 days for CAP in eligible patients (1).

“Since shortening the course of recommended antibiotics, there's been no increase in those prescriptions… which really shows that these kids are still… being successfully treated,” Pifko noted.

A key success factor was monthly feedback reports to providers, which Pifko said “really can help sustain a change.”

Disclosures: Elysha Pifko reports no relevant disclosures.

Reference:

1. Pifko E. Decreasing Ambulatory Antibiotic Treatment Duration for Acute Otitis Media and Community-Acquired Pneumonia within a Pediatric Integrated Healthcare System Abstract. Presented at: Pediatric Academic Societies 2025 Meeting; April 24-28, 2025. Honolulu, Hawaii.