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Improving Antibiotic Prescribing for Children with Community-acquired Pneumonia in Outpatient Settings
Matthew F Daley1, Liza M Reifler2, Andrew T Sterrett2
1Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Insights
A two-phase intervention improved antibiotic prescribing for pediatric community-acquired pneumonia. The study showed increased use of narrow-spectrum antibiotics and shorter treatment durations in children.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Health services research
Background:
- Community-acquired pneumonia (CAP) is a common pediatric illness.
- Antibiotic overuse contributes to antimicrobial resistance.
- Optimizing antibiotic prescribing for pediatric CAP is crucial.
Purpose of the Study:
- To evaluate a two-phase intervention's impact on antibiotic prescribing for pediatric CAP.
- To assess changes in antibiotic choice and duration.
Main Methods:
- A two-phase intervention involving clinician education and electronic health record order sets was implemented.
- Interrupted time series analysis compared antibiotic prescribing before and after the intervention phases.
- Data from 3570 pediatric CAP cases were analyzed.
Main Results:
- The proportion of children receiving narrow-spectrum monotherapy increased significantly post-intervention (40.6% to 68.4%-69.0%).
- Mean antibiotic duration decreased from 9.9 days preintervention to 6.8 days post-phase two.
- These improvements were sustained across both intervention phases.
Conclusions:
- A multi-component intervention effectively improved antibiotic choice and duration for pediatric CAP.
- Educational sessions and clinical decision support are key to optimizing antimicrobial use.
- Sustained improvements demonstrate the intervention's long-term value.
Objective:
To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia.
Study Design:
In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record. In October 2021, a second phase comprised additional education and order set revisions. A narrow spectrum antibiotic (eg, amoxicillin) was recommended in most circumstances. Electronic health record data were used to identify pneumonia cases and antibiotics ordered. Using interrupted time series analyses, antibiotic choice and duration after phase one (September 2020-September 2021) and after phase two (October 2021-October 2022) were compared with a preintervention prepandemic period (January 2016-early March 2020).
Results:
Overall, 3570 cases of community-acquired pneumonia were identified: 3246 cases preintervention, 98 post-phase one, and 226 post-phase two. The proportion receiving narrow spectrum monotherapy increased from 40.6% preintervention to 68.4% post-phase one to 69.0% post-phase two (P < .001). For children with an initial narrow spectrum antibiotic, duration decreased from preintervention (mean duration 9.9 days, SD 0.5 days) to post-phase one (mean 8.2, SD 1.9) to post-phase two (mean 6.8, SD 2.3) periods (P < .001).
Conclusions:
A two-phase intervention with educational sessions combined with clinical decision support was associated with sustained improvements in antibiotic choice and duration among children with community-acquired pneumonia.
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