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  • Publication # 14-RA004

Outpatient antimicrobial stewardship program lowers use of broadspectrum antibiotics by pediatricians

Patient Safety and Quality of Care

Unnecessary prescribing of antibiotics for acute respiratory tract infections (ARTIs) caused by viruses, which don't respond to antibiotics, has been declining. However, inappropriate prescribing also occurs for bacterial ARTIs, particularly when broad-spectrum antibiotics are used to treat infections for which narrow-spectrum antibiotics are indicated and recommended. 

An outpatient antimicrobial stewardship program can improve pediatricians' antibiotic prescribing practices, according to a new study. It found that when a program to reduce the overuse of broad-spectrum antibiotics was implemented, among children who were prescribed antibiotics for any indication, the overall proportion of broad-spectrum antibiotics prescribed decreased from 26.8 percent to 14.3 percent in the intervention group and from 28.4 percent to 22.6 percent in the control group. 

Photograph shows a pediatrician examining a little girl's ear. The program involved clinician education coupled with audit and feedback of antibiotic prescribing across a pediatric primary care network with 18 practices. During the study period, there were 1,291,824 office visits by 185,212 patients. The researchers tracked antibiotic use for pneumonia, streptococcal pharyngitis, and acute sinusitis during a 12-month period following initiation of the program. 

Off-guideline antibiotic prescribing for pneumonia decreased from 15.7 percent to 4.2 percent in the intervention group, compared with a decline from 17.1 percent to 16.3 percent in the control group.Broad-spectrum prescribing for acute sinusitis decreased from 38.9 percent to 18.8 percent in the intervention group and from 40.0 percent to 33.9 percent in the control group. Broad-spectrum prescribing for both streptococcal pharyngitis and viral ARTIs was low at baseline and remained unchanged. 

Despite professional society recommendations that penicillin or amoxicillin be used as first-line agents for streptococcal pharyngitis, acute sinusitis, and pneumonia, roughly 50 percent of children receive broader-spectrum antibiotics for these common infections. Antimicrobial stewardship programs are recommended to optimize antimicrobial use in hospitalized patients, most often through the use of prospective audit and feedback of antibiotic prescribing. In contrast, few recommendations for outpatients are offered, largely because data is lacking regarding effective interventions in ambulatory medicine. 

These findings suggest that extending antimicrobial stewardship to the ambulatory setting, where such programs have generally not been implemented, may have important health benefits, including reduced antibiotic resistance pressure, and unnecessary adverse drug effects. This study was supported by AHRQ (Contract No. 290-07-10013). 

See "Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians," by Jeffrey S. Gerber, M.D., Ph.D., Priya A. Prasad, M.P.H., Alexander G. Fiks, M.D., and others in the June 12, 2013, Journal of the American Medical Association 309(22), pp. 2345-2352.


Page last reviewed February 2014
Internet Citation: Outpatient antimicrobial stewardship program lowers use of broadspectrum antibiotics by pediatricians: Patient Safety and Quality of Care. February 2014. Agency for Healthcare Research and Quality, Rockville, MD.


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