Identifying successful pediatric outpatient antimicrobial stewardship strategies through benchmarking: A...

We evaluated the impact of benchmarking on antibiotic prescribing and identified antibiotic stewardship strategies affecting pediatric outpatient antibiotic prescribing.

The Sharing Antimicrobial Reports for Pediatric Stewardship-Outpatient Collaborative shared quarterly benchmarking reports with 22 institutions on antibiotic prescribing metrics (percentage of acute and acute respiratory infection [ARI] encounters with antibiotic prescriptions, duration of ≤ 7days, and among ARI, rates of amoxicillin and azithromycin use) for emergency departments, urgent care clinics, and primary care clinics. In January 2024, a survey assessed stewardship strategies and the impact of the benchmarking reports. We compared baseline (January 2019-December 2022) with the benchmarking period (January 2023-September 2024).

We included 32.4 million acute encounters. Although antibiotic prescribing increased in the benchmarking period, we saw increased amoxicillin use, decreased azithromycin use, and decreased antibiotic duration. The odds of receiving antibiotics for ARI were variable across practice settings and strategies, although institutions that used guidelines, electronic record features, and quality improvement projects observed lower antibiotic and azithromycin use and higher amoxicillin use.

Although we did not observe a decrease in antibiotic prescribing for ARI after providing benchmarking reports, there was improvement in antibiotic selection. Guidelines and quality improvement initiatives may have the biggest impact on antibiotic prescribing metrics.