Antimicrobial stewardship reduces broad-spectrum antibiotic use in pediatrics

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1. In an outpatient pediatrics setting, the implementation of an antimicrobial stewardship program decreased the prescription of broad-spectrum antibiotics from 26.8% to 14.3%. 

2. The prescription of antibiotics for streptococcal pharyngitis or viral infections did not change significanty from baseline with implementation of the antimicrobial stewardship program. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: The implementation of an antimicrobial stewardship program, involving education, auditing and feedback, in an outpatient pediatric population decreased broad-spectrum antibiotic prescribing for children with acute respiratory tract infections. In comparison to the control groups, the implementation of an antibiotic stewardship program also improved compliance with antibiotic prescribing guidelines. These findings suggest that the applications of antimicrobial stewardship programs are not only effective in the inpatient setting but also in outpatient settings to decrease unnecessary antibiotic prescribing.

One limitation to this study was that it did not allow for identification of the specific elements (e.g. education, auditing, or feedback) of the implemented program that most contributed to the reduction in off-guideline antibiotic prescribing by clinicians. Future studies should attempt to characterize which factors of the implemented antimicrobial stewardship program contribute most significantly to the reduction of antibiotic use. This will hopefully allow for the development of maximally cost effective programs to reduce off-guideline prescribing of antibiotics in pediatrics.

Click to read the study, published today in JAMA

Relevant Reading: Antibiotic prescribing in ambulatory pediatrics in the United States

In-Depth [randomized trial]: This trial included 18 practice groups in the northeast US, 9 of which were randomized to the intervention group and 9 to the control group. The 9 practice groups in the intervention group each received an on-site clinician education session and were followed quarterly with audits and feedback regarding antibiotic prescribing. All practice groups were examined for rates of off-guideline antibiotic prescribing for acute respiratory tract infections and viral infections with a follow-up of one year.

Overall broad spectrum antibiotic prescribing had a significantly greater decrease in the intervention group (15.7% to 4.2%) relative to the control group (26.8% to 14.3%, degree of differences 6.7%, p=0.01). Off-guideline prescribing was decreased for children with pneumonia (15.7% vs. 4.2%, p<0.001), with a trend for significance in the decrease of off-guideline antibiotic prescribing for children with sinusitis (38.9% vs. 18.8%, p=0.12). The antibiotic prescribing rate did not significantly differ for viral infections in either group (p=0.93). 

By Brittany Hasty and Rif Rahman 

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