Antibiotic Stewardship for Community-Acquired Pediatric Pharyngitis: A Pre-Post Intervention Study
Maayan Diti Machnes1, Herman Avner Cohen1, Maya Gerstein1
1Pediatric Ambulatory Community Clinic, Petach Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
An antibiotic stewardship program (ASP) slightly reduced unnecessary antibiotic prescriptions for pediatric Group A Streptococcus (GAS) pharyngitis. The program improved testing but did not alter antibiotic choice or reduce broad-spectrum use.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Group A Streptococcus (GAS) pharyngitis is a common bacterial infection in children, often clinically indistinguishable from viral pharyngitis.
- Antibiotic overuse is prevalent in pediatric pharyngitis, despite a high incidence of viral infections.
Purpose of the Study:
- To evaluate the impact of an antibiotic stewardship program (ASP) on antibiotic prescribing practices for pediatric GAS pharyngitis.
- To assess changes in diagnostic testing and antibiotic selection following the ASP intervention.
Main Methods:
- A quasi-experimental design comparing antibiotic prescription data from pre-intervention (2016-2017) and post-intervention (2017-2018) periods.
- The intervention involved a one-day educational seminar for pediatricians on GAS pharyngitis diagnosis and treatment guidelines.
Main Results:
- A decrease in the percentage of children receiving no laboratory testing for GAS pharyngitis (68% to 63%).
- An increase in rapid antigen detection testing (28% to 32%) and throat cultures (3% to 4%).
- No significant change in the types of antibiotics prescribed, including broad-spectrum agents and macrolides.
Conclusions:
- The ASP led to a modest improvement in diagnostic testing for GAS pharyngitis.
- The program achieved a slight reduction in overall antibiotic prescriptions for GAS pharyngitis.
- The ASP did not effectively reduce the prescription of broad-spectrum antibiotics or macrolides.
Background:
Group A Streptococcus (GAS), the predominant bacterial pathogen of pharyngitis, is sometimes difficult to distinguish clinically from viral pharyngitis. Despite the high prevalence of viral pharyngitis in children, antibiotic treatment is common.
Objectives:
To investigate the effectiveness of an antibiotic stewardship program (ASP) on antibiotic prescription in children with GAS pharyngitis (GAS-P) at a large pediatric community clinic.
Methods:
Antibiotic prescription data were collected from October 2016 to March 2017 (pre-intervention period) and from October 2017 to March 2018 (post-intervention period). The intervention was a one-day seminar for primary care pediatricians on the diagnosis and treatment of GAS-P in children according to national guidelines.
Results:
The overall prevalence of testing differed between the two time periods. There was a decrease in children who did not undergo any testing (from 68% to 63%), an increase in streptococcal rapid antigen detection testing (28% to 32%), and a slight increase in throat cultures (3% to 4%) (P = 0.02). There was no change in the types of antibiotics prescribed before and after the intervention (P = 0.152).
Conclusions:
The ASP resulted in a slight reduction in the percentage of children who did not undergo laboratory testing for GAS-P and a slight reduction in the percentage of children who received antibiotic treatment. The ASP did not reduce the use of broad-spectrum antibiotics and macrolides.
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