Program cuts inappropriate antibiotic use in kids

An educational intervention, which includes periodic feedback to pediatricians, reduces inappropriate outpatient prescribing of broad-spectrum antibiotics to children with respiratory infections by about half, according to a new randomized trial.

The Centers for Disease Control and Prevention has noted that although the overall antibiotic prescribing rate for children aged 14 years and younger has decreased, the rate remains inappropriately high.

In an effort to find new ways of reducing inappropriate prescribing of broad-spectrum antibiotics, researchers from the Children’s Hospital of Philadelphia and the University of Pennsylvania investigated the prescribing practices of 162 clinicians from 18 primary care practices in Pennsylvania and New Jersey. The investigators focused on antibiotic prescriptions written for 20 months before and 12 months after applying an antibiotic stewardship intervention. In all, information from a total of 1,291,824 office visits by 185,212 unique patients was used.

The intervention consisted of a single, 1-hour long, on-site education session during which a pediatrician who was board certified in infectious diseases provided information about the latest antibiotic prescribing recommendations. This was followed with a personalized audit and feedback of prescribing patterns every 4 months for 1 year.

Of the children who received antibiotics for any reason, the percentage of the drugs prescribed that were considered to be broad spectrum fell from 26.8% to 14.3% in the intervention group versus from 28.4% to 22.6% in the control group. The drop was most pronounced in the group of children with pneumonia. In that group, prescribing of broad-spectrum agents fell from 15.7% to 4.2% versus from 17.1% to 16.3% in the control group of children with pneumonia.

The researchers note that respiratory infections, including acute sinusitis, streptococcal pharyngitis, and pneumonia, are among the most frequent indications for antibiotic prescriptions in children, and that pneumonia is one of the most common indications for off-guideline antibiotic prescribing.