Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department
Maria Carmen G Diaz1, Nadine Symons, Maria L Ramundo
1Department of Pediatrics, Northeastern Ohio Universities College of Medicine, and Pediatric Emergency Services, Children's Hospital Medical Center of Akron, Akron, Ohio, USA. mcdiaz@NEMOURS.org
Insights
Implementing evidence-based guidelines significantly improved antibiotic prescribing for pediatric pharyngitis in an emergency department. This approach led to more appropriate treatment decisions, reducing unnecessary antibiotic use and enhancing patient care.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Clinical Practice Guidelines
Background:
- Pharyngitis is a frequent pediatric complaint, often leading to misdiagnosis of bacterial infections based on clinical signs alone.
- Non-standardized treatment approaches in emergency departments contribute to antibiotic resistance and adverse events.
- Accurate diagnosis is crucial to avoid inappropriate empirical antibiotic therapy.
Purpose of the Study:
- To implement evidence-based guidelines for diagnosing and treating pediatric pharyngitis in emergency departments.
- To influence antibiotic prescribing practices among pediatric emergency physicians.
- To improve the appropriateness of antibiotic use in pediatric pharyngitis cases.
Main Methods:
- Development and implementation of an evidence-based clinical guideline for pharyngitis evaluation and treatment.
- Comparison of preintervention and postintervention patient cohorts using medical record review.
- Assessment of treatment appropriateness based on confirmatory microbiological testing for Group A beta-hemolytic streptococci.
Main Results:
- The study included 443 pediatric patients (219 preintervention, 224 postintervention).
- Appropriate treatment rates increased from 44% in the preintervention group to 91% in the postintervention group.
- Implementation of the guideline significantly improved the appropriateness of antibiotic prescribing.
Conclusions:
- Evidence-based clinical guidelines effectively improve antibiotic prescribing practices in pediatric emergency settings.
- Guidelines enhance the appropriate diagnosis and treatment of pediatric pharyngitis.
- This strategy can help combat antibiotic resistance and improve patient outcomes.
Background:
Pharyngitis is a common complaint in pediatric patients. If clinical parameters are used alone, bacterial pathogens will be wrongly implicated in many cases. A nonstandardized approach to the treatment of children with pharyngitis in an emergency department setting may lead to inappropriate empirical therapy, contribute to increased bacterial resistance, and result in adverse events related to the treatment provided.
Objective:
To implement evidence-based guidelines for the diagnosis and treatment of children with pharyngitis in an emergency department setting and thereby influence practices of prescribing antibiotics.
Design And Methods:
An evidence-based guideline for the evaluation and treatment of patients with pharyngitis was developed and implemented in our emergency department. Preintervention and postintervention patient cohorts were identified by a search of the emergency department's clinical repository. A medical record review was performed using a standardized data abstraction form (history and examination data, diagnostic testing, and therapy provided). Treatment decisions were judged as appropriate if the diagnosis of pharyngitis caused by group A beta-hemolytic streptococci was based on confirmatory microbiological testing rather than on the history and physical examination findings alone.
Results:
We included 443 patients for study (219 preintervention and 224 postintervention). In the preintervention group, 97 (44%) of 214 received appropriate treatment. In the postintervention group, 204 (91%) of 224 received appropriate treatment.
Conclusion:
An evidence-based clinical guideline can influence and improve practices of prescribing antibiotics by pediatric emergency physicians in a teaching hospital setting.
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