Improving Antibiotic Use in Pediatric Preseptal Cellulitis Using a Clinical Practice Guideline.

Area of Science:

• Pediatric infectious diseases
• Clinical practice guidelines
• Antibiotic stewardship

Background:

• Preseptal cellulitis is a common pediatric infection.
• Antibiotic overuse is a significant concern in pediatric care.
• Clinical practice guidelines (CPGs) can standardize treatment and improve outcomes.

Purpose of the Study:

• To evaluate the impact of a clinical practice guideline (CPG) on antibiotic prescribing patterns and resource utilization for pediatric preseptal cellulitis.
• To assess the effectiveness of a multifaceted implementation strategy for a CPG.

Main Methods:

• Retrospective quasiexperimental study of 236 pediatric patients (2 months to 17 years) with preseptal cellulitis.
• Comparison of antibiotic use and resource utilization before (2013-2020) and after (2020-2023) CPG implementation.
• Primary outcomes: broad-spectrum antibiotic use (dual/triple therapy, MRSA-active agents). Secondary outcomes: blood testing and imaging.

Main Results:

• Post-CPG implementation, broad-spectrum antibiotic use decreased from 100% to 66% (P < .001).
• Use of dual/triple therapy dropped from 47% to 16% (P < .001), and MRSA-active agents from 86% to 26% (P < .001).
• Orders for complete blood count decreased from 75% to 57% (P = .014), and blood cultures from 32% to 18% (P = .047).

Conclusions:

• Implementation of a CPG significantly reduced broad-spectrum antibiotic use in pediatric preseptal cellulitis.
• The CPG also led to decreased utilization of blood testing and imaging.
• CPGs are effective tools for optimizing antibiotic stewardship in pediatric infections.