Impact of Implementing National Guidelines on Antibiotic Prescriptions for Acute Respiratory Tract Infections in
Naïm Ouldali1,2, Xavier Bellêttre3, Karen Milcent4,5
1Department of Medicine, Paris Diderot University.
Insights
Implementing national guidelines significantly reduced antibiotic prescriptions for acute respiratory tract infections (ARTI) in pediatric emergency departments (PEDs). This antimicrobial stewardship intervention avoided over 13,000 prescriptions, favoring amoxicillin over broad-spectrum antibiotics.
Area of Science:
- Pediatric Emergency Medicine
- Antimicrobial Stewardship
- Infectious Diseases
Background:
- Inappropriate antibiotic prescribing is common in pediatric emergency departments (PEDs).
- Limited data exist on effective interventions for antimicrobial stewardship in PEDs.
- National guidelines for acute respiratory tract infections (ARTI) aim to optimize antibiotic use.
Purpose of the Study:
- To assess the impact of implementing 2011 national guidelines on antibiotic prescriptions for ARTI in French PEDs.
- To evaluate the effectiveness of an antimicrobial stewardship intervention in a real-world clinical setting.
Main Methods:
- A multicenter, quasiexperimental, interrupted time series analysis was conducted.
- Prospective electronic data from 7 French PEDs (November 2009-October 2014) were analyzed.
- Intervention included protocol implementation, education, and feedback; segmented regression analyzed prescription rates.
Main Results:
- 242,534 pediatric ARTI cases were included.
- Antibiotic prescription rates significantly decreased (-0.4% per 15-day period, P=.04).
- Cumulative reduction was 30.9%, avoiding 13,136 prescriptions; broad-spectrum antibiotic use dropped 62.7% in favor of amoxicillin.
Conclusions:
- Implementation of national guidelines effectively reduced antibiotic prescribing for ARTI in PEDs.
- The intervention promoted appropriate antibiotic selection, shifting towards amoxicillin.
- This study demonstrates a successful antimicrobial stewardship strategy in pediatric emergency care.
Background:
Many antibiotics are prescribed inappropriately in pediatric emergency departments (PEDs), but little data are available in these settings about effective interventions based on guidelines that follow the antimicrobial stewardship principle. Our aim was to assess the impact of implementing the 2011 national guidelines on antibiotic prescriptions for acute respiratory tract infection (ARTI) in PEDs.
Method:
We conducted a multicentric, quasiexperimental, interrupted time series analysis of prospectively collected electronic data from 7 French PEDs. We included all pediatric patients who visited a participating PED during the study period from November 2009 to October 2014 and were diagnosed with an ARTI. The intervention consisted of local protocol implementation, education sessions, and feedback. The main outcome was the antibiotic prescription rate of discharge prescriptions for ARTI per 1000 PED visits before and after implementation, analyzed using the segmented regression model.
Results:
We included 242534 patients with an ARTI. The intervention was associated with a significant change in slope for the antibiotic prescription rate per 1000 PED visits (-0.4% per 15-day period, P = .04), and the cumulative effect at the end of the study was estimated to be -30.9%, (95% CI [-45.2 to -20.1]), representing 13136 avoided antibiotic prescriptions. The broad-spectrum antibiotic prescription relative percentage decreased dramatically (-62.7%, 95% CI [-92.8; -32.7]) and was replaced by amoxicillin.
Conclusion:
Implementation of the 2011 national French guidelines led to a significant decrease in the antibiotic prescription rate for ARTI and a dramatic drop in broad-spectrum antibiotic prescriptions, in favor of amoxicillin.
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