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Improving antibiotic prescribing in the emergency department for uncomplicated community-acquired pneumonia
Rebekah Shaw1, Erica Popovsky1, Alyssa Abo2,3
1Division of Pediatrics, Children's National Health System, Washington, DC, USA.
Insights
Pediatric Infectious Disease Society (PIDS) and Infectious Disease Society of America (IDSA) guideline knowledge is high, but prescribing practices for community-acquired pneumonia (CAP) in children did not improve after clinical practice guideline (CPG) implementation.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Practice Guidelines
- Antibiotic Stewardship
Background:
- The Pediatric Infectious Disease Society (PIDS) and Infectious Disease Society of America (IDSA) recommend aminopenicillins for uncomplicated community-acquired pneumonia (CAP) in children.
- Guideline compliance remains a challenge, with 10-50% of hospitalized children receiving broad-spectrum antibiotics.
- A clinical practice guideline (CPG) was implemented in an emergency department (ED) to address uncomplicated CAP.
Purpose of the Study:
- To assess emergency department (ED) provider knowledge of PIDS/IDSA guidelines for uncomplicated CAP.
- To evaluate ED provider antibiotic prescribing patterns for uncomplicated CAP before and after CPG implementation.
Main Methods:
- An anonymous, case-based survey assessed provider knowledge of PIDS/IDSA guidelines.
- A retrospective chart review analyzed intravenous antibiotic prescribing for CAP in the ED from January 2015 to February 2017.
- Prescribing patterns were compared pre- and post-CPG implementation.
Main Results:
- 86.4% of ED providers were aware of the PIDS/IDSA guideline recommendations, identifying ampicillin as the preferred initial antibiotic.
- Only 41.2% of hospitalized patients with uncomplicated CAP received ampicillin pre-CPG (P<0.01).
- No significant increase in ampicillin prescribing was observed post-CPG implementation (P=0.40).
Conclusions:
- ED providers demonstrate awareness of PIDS/IDSA guidelines for uncomplicated CAP first-line therapy.
- Knowledge of guidelines does not consistently translate into clinical practice.
- Isolated CPG implementation did not significantly alter prescribing patterns for uncomplicated CAP.
Background:
The Pediatric Infectious Disease Society (PIDS) and Infectious Disease Society of America (IDSA) published an evidence-based guideline for the treatment of uncomplicated community-acquired pneumonia (CAP) in children, recommending aminopenicillins as the first-line therapy. Poor guideline compliance with 10%-50% of patients admitted to the hospital receiving narrow-spectrum antibiotics has been reported. A new clinical practice guideline (CPG) was implemented in our emergency department (ED) for uncomplicated CAP. The aim of this study was to examine baseline knowledge and ED provider prescribing patterns pre- and post-CPG implementation.
Methods:
Prior to CPG-implementation, an anonymous case-based survey was distributed to evaluate knowledge of the current PIDS/IDSA guideline. A retrospective chart review of patients treated in the ED for CAP from January 2015 to February 2017 was performed to assess prescribing patterns for intravenous (IV) antibiotics in the ED at Children's National Health System pre- and post-CPG implementation.
Results:
ED providers were aware of the PIDS/IDSA guideline recommendations, with 86.4% of survey responders selecting ampicillin as the initial antibiotic of choice. However, only 41.2% of patients admitted to the hospital with uncomplicated CAP pre-CPG received ampicillin (P<0.01). There was no statistically significant increase in ampicillin prescribing post-CPG (P=0.40).
Conclusions:
Providers in the ED are aware of the PIDS/IDSA guideline regarding the first-line therapy for uncomplicated CAP; however, this knowledge does not translate into clinical practice. Implementation of a CPG in isolation did not significantly change prescribing patterns for uncomplicated CAP.
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