Interventions Reduce Antibiotic Prescriptions Given by Primary Care Pediatricians

Antimicrobial stewardship programs may reduce the amount of inappropriate antibiotic prescriptions given to children with acute respiratory infections in primary care practices.

Evidence has shown antimicrobial stewardship programs to be effective in reducing inappropriate antibiotic prescriptions among inpatients, and new research suggests that similar programs may also decrease the amount of antibiotic prescriptions among outpatients with common respiratory infections, who receive the majority of antibiotics.

The study, published in the June 12, 2013, issue of JAMA, analyzed the effect of an antimicrobial stewardship intervention on prescription patterns for antibiotics not recommended by guidelines given to children with acute sinusitis, streptococcal pharyngitis, and pneumonia in 18 primary care practices located in Pennsylvania and New Jersey. Half of participating practices were assigned to the intervention, which began in June 2010 and included an hour-long clinician education session on current prescribing guidelines for respiratory infections and personalized feedback reports on prescriptions given to physicians every 4 months for 1 year.

Data on prescribing information were collected from October 2008, 20 months before the intervention began, through June 2011, 1 year after the intervention, from an electronic health record. Children with chronic medical conditions and antibiotic allergies, as well as children who had previously used antibiotics, were excluded from the study. Amoxicillin-clavulanate, second- and third-generation cephalosporins, and azithromycin were considered to be against prescribing guidelines.

After adjusting for age, sex, race, and insurance, prescriptions for nonrecommended antibiotics among the intervention group decreased from 26.8% before the intervention to 14.3% (a total decrease of 12.5%) during the year after the intervention. In control practices, prescriptions for these antibiotics only decreased from 28.4% to 22.6% (a total decrease of 5.8%). For children with pneumonia, antibiotic prescribing decreased from 15.7% to 4.2% (a total decrease of 75%) among those who visited intervention practices and from 17.1% to 16.3% among controls. Inappropriate prescribing decreased from 38.9% to 18.8% and from 40% to 33.9% for children diagnosed with acute sinusitis who visited intervention practices and control practices, respectively. Prescription rates for nonrecommended antibiotics to treat streptococcal pharyngitis and viral infections were low at baseline and changed little throughout the study.

The results indicate that antimicrobial stewardship interventions may be just as effective in outpatient settings as they are in inpatient settings.

“Because most antibiotic use occurs in outpatients, it is essential to apply stewardship principles to ambulatory medicine to maximize the population benefits of more judicious antibiotic use, including reduced antibiotic resistance pressure and unnecessary adverse drug effects and health care costs,” the authors write.

They suggest that future research should investigate the main causes behind these changes in antibiotic prescriptions and the efficacy of similar programs in other health settings.