Related Experiment Video
Updated: Feb 16, 2026
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Antimicrobial Stewardship Program Using Plan-Do-Study-Act Cycles to Reduce Unjustified Antibiotic Prescribing in
Sasha E Dorzin1, Claudia Halaby1, Maria Lyn Quintos1
1Department of Pharmacy (SED, GE), NYU Winthrop Hospital, Mineola, New York, Pediatric Pulmonary Medicine (CH), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Quality and Patient Safety (MLQ), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Pediatric Infectious Diseases (AN), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Pharmacy (GE), NYU Winthrop Hospital, Mineola, New York, and Department of Clinical Health Professions, St John's University College of Pharmacy and Health Sciences, Jamaica, New York.
Insights
An antimicrobial stewardship program (ASP) successfully reduced unjustified antibiotic use in children with asthma by 25%. This initiative lowered the rate of unnecessary antibiotic prescriptions to 5.9%, surpassing national guidelines.
Area of Science:
- Pediatric pulmonology
- Infectious diseases
- Antimicrobial resistance
Background:
- National asthma guidelines advise against antibiotics for exacerbations unless infection or comorbidities are present.
- A prior study at the institution found 7.8% of antibiotics were unjustified in pediatric asthma admissions.
- The American Academy of Pediatrics benchmark for unjustified antibiotic use is 6.6%.
Purpose of the Study:
- To decrease unjustified antibiotic use by 25% in pediatric asthma patients.
- To implement an antimicrobial stewardship program (ASP) targeting asthma exacerbations.
- To align antibiotic prescribing with established national guidelines.
Main Methods:
- A multidisciplinary team implemented interventions using Plan-Do-Study-Act cycles over a 5-month period (November 2015-March 2016).
- Interventions included disseminating asthma guidelines, educating pediatric emergency department staff, and conducting a journal club on azithromycin's role.
- The study included children aged 6 months to 17 years admitted for asthma exacerbations, excluding those with comorbidities.
Main Results:
- The unjustified antibiotic prescribing rate decreased from 8.3% in Cycle 1 to 8.7% in Cycle 2, and ultimately to 0% in Cycle 3.
- Across all cycles, 68 patients were evaluated, with a final unjustified antibiotic prescribing rate of 5.9%.
- This represents a 25% reduction in unjustified antibiotic use, meeting the study's primary objective.
Conclusions:
- The implemented antimicrobial stewardship program effectively reduced unjustified antibiotic use in pediatric asthma patients.
- The study achieved a 5.9% unjustified antibiotic prescribing rate, which is below the American Academy of Pediatrics benchmark of 6.6%.
- This demonstrates the success of targeted ASP interventions in optimizing antibiotic prescribing for pediatric asthma.
Objective:
Antimicrobial stewardship programs (ASPs) ensure appropriate antibiotic use, reduce health care costs, and minimize antibiotic resistance. National asthma guidelines do not recommend antibiotics during an exacerbation unless the child has an infection or comorbidities. The American Academy of Pediatrics (AAP) established a benchmark for unjustified antibiotic use at 6.6%.9 A retrospective study at our institution showed that 7.8% of antibiotics were prescribed without justification in children admitted for asthma. The purpose of this study was to reduce unjustified antibiotic use at our institution by 25% in children through an ASP directed toward asthma.
Methods:
The study period lasted from November 2015 to March 2016. Children 6 months to 17 years of age, admitted for an asthma exacerbation, were included while those with comorbidities were excluded. A multidisciplinary team from pediatric pharmacotherapy, pulmonology, emergency department (ED), infectious diseases, and quality improvement was formed to focus on process improvement. Interventions were executed in a series of Plan-Do-Study-Act cycles. In cycle 1, our asthma guidelines on appropriate antibiotic use were disseminated to pediatric house staff and posted in pediatric units. Cycle 2 encompassed presenting the ASP and guidelines to the pediatric ED staff. Cycle 3 consisted of a journal club with the pulmonary division to discuss the role of azithromycin in an asthma exacerbation.
Results:
In cycle 1, twenty-four patients were reviewed in November 2015. Antibiotics were prescribed in 8/24 (33%) children, with an unjustified rate of 2/24 (8.3%). In cycle 2, twenty-three patients were reviewed in December and January with 8/23 (35%) prescribed antibiotics and an unjustified rate of 2/23 (8.7%). For cycle 3, in February and March 2016, twenty-one children were reviewed. Antibiotics were prescribed in 6/21 (27%) children and all were justified. In total, 68 patients were included in our study and had an unjustified antibiotic prescribing rate of 4/68 (5.9%), a reduction of 25%.
Conclusion:
Our ASP surpassed the benchmark set by AAP guidelines, by reducing the percentage of unjustified antibiotics in children with asthma to 5.9%.
Related Concept Videos
00:57Antibiotic Selection
01:29Asthma-I: Introduction
01:28Antimicrobial Effectiveness
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.