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Updated: Nov 21, 2025

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Intermittent Education and Audit and Feedback Reduce Inappropriate Prescribing of Oral Third-Generation

Margaret Taylor, Sara Liechti, Debra Palazzi

    Joint Commission Journal on Quality and Patient Safety
    |January 15, 2021
    PubMed

    Insights

    Antimicrobial stewardship interventions significantly reduced inappropriate oral third-generation cephalosporin prescribing in pediatric clinics. These improvements were sustained, even with decreased provider participation in stewardship activities.

    Area of Science:

    • Pediatric Infectious Diseases
    • Antimicrobial Stewardship
    • Quality Improvement in Healthcare

    Background:

    • High rates of oral third-generation cephalosporin (oTGC) use were identified in a pediatric ambulatory care network.
    • Concerns were raised regarding inappropriate oTGC prescribing practices in outpatient clinics.

    Purpose of the Study:

    • To reduce inappropriate oTGC prescribing by 15% within one year at a specific clinic (Clinic A).
    • To evaluate the effectiveness of quality improvement interventions on antibiotic prescribing patterns.

    Main Methods:

    • A quality improvement team implemented Plan-Do-Study-Act (PDSA) cycles, including educational sessions and audit/feedback.
    • The primary outcome measured was the percentage of oTGCs not aligning with American Academy of Pediatrics (AAP) guidelines.
    • oTGC prescribing at Clinic A was compared to four control clinics.

    Main Results:

    • Inappropriate oTGC prescribing at Clinic A decreased from 72% to 45% post-intervention, a statistically significant reduction.
    • This reduction was sustained for the year following the intervention period.
    • Total oTGC prescribing decreased at Clinic A but not in control clinics, despite declining provider participation.

    Conclusions:

    • Intermittent education and audit/feedback effectively reduced oTGC misuse in pediatric outpatient settings.
    • Prescribing improvements were maintained, suggesting that ongoing audit perceptions can sustain stewardship efforts.
    • Quality improvement initiatives are crucial for optimizing antibiotic prescribing in ambulatory care.
    Abstract

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