Reducing Ophthalmic Antibiotic Use for Non-severe Conjunctivitis in Children
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Published on: May 31, 2024
Thresia Sebastian1,2,3, Josh Durfee4, Nancy Wittmer4
1Department of Pediatrics, Denver Health and Hospital Authority, Denver, Colorado, USA.
Insights
A quality improvement intervention significantly reduced antibiotic prescribing for pediatric conjunctivitis. This approach did not increase treatment failure rates, demonstrating effective antibiotic stewardship in children.
Area of Science:
- Pediatric infectious diseases
- Quality improvement in healthcare
- Ophthalmology
Background:
- Antibiotic overprescription for pediatric conjunctivitis is a significant concern.
- System-level quality improvement (QI) interventions are crucial for optimizing antibiotic use.
Purpose of the Study:
- To evaluate a multi-faceted QI intervention aimed at reducing unnecessary ophthalmic antibiotic use in children with conjunctivitis.
- To assess the impact of the intervention on antibiotic prescribing rates, treatment failure, and healthcare utilization.
Main Methods:
- A multi-faceted QI intervention was implemented, including clinical pathways, nurse protocols, EHR modifications, and educational materials.
- A multi-interrupted time series model analyzed data from children aged 6 months to 17 years between November 2018 and December 2022.
- Fisher's exact tests compared outcomes between different time periods and treatment groups.
Main Results:
- Ophthalmic antibiotic use decreased by 18.8% from the pre-intervention to post-intervention periods.
- The intervention led to an additional 2.7% reduction in prescribing, particularly in younger children.
- Treatment failure was more common in children who received ophthalmic antibiotics (20.0%) compared to those who did not (17.9%).
Conclusions:
- The QI intervention effectively reduced ophthalmic antibiotic prescribing for pediatric conjunctivitis.
- The reduction in antibiotic use was achieved without an increase in treatment failure rates or healthcare utilization.
- This study highlights the success of a system-level approach to antibiotic stewardship in pediatric ophthalmology.
Background:
Antibiotics are often overprescribed for pediatric conjunctivitis. We implemented a system-level quality improvement (QI) intervention to reduce unnecessary ophthalmic antibiotic use.
Methods:
The multi-faceted intervention in Denver, CO comprised a clinical care pathway, nurse protocol modifications, electronic health record (EHR) changes, parent education materials, and clinician education. We evaluated children aged 6 months-17 years with conjunctivitis seen between November 2018 and December 2022. A multi-interrupted time series model evaluated the effectiveness of the intervention over three time periods: Pre-COVID, Pre-Intervention (November 2018-February 2020), COVID, Pre-Intervention (March 2020-March 2021), and Post-Intervention (April 2021-December 2022). Fisher's exact tests compared treatment failure and healthcare utilization rates between time periods and among children receiving or not receiving ophthalmic antibiotics.
Results:
Among 6960 eligible encounters, ophthalmic antibiotic use was reduced by 18.8% (95% CI: 16.3, 21.3) from Pre-COVID, Pre-Intervention to Post-Intervention. During the Pre-Intervention period following the onset of COVID, a reduction of 16.1% (95% CI: 12.9, 19.3) was observed. Implementation of the intervention resulted in an additional 2.7% (95% CI: -0.4, 5.7) reduction in antibiotic prescribing, primarily in younger children (ages 6 months-5 years). The greatest reduction in prescribing occurred for nurse triage encounters with an 82.1% (95% CI: 76.8, 87.5) reduction in prescribing rates (92.6%-10.5%). Treatment failure occurred in 1301 (18.7%) children and was more common among children that received an ophthalmic antibiotic than those that did not (20.0 vs 17.9%; P = .03).
Conclusion:
The QI intervention significantly reduced ophthalmic antibiotic prescribing for pediatric conjunctivitis without increasing treatment failure rates or health care utilization.
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