Decreasing Ambulatory Antibiotic Treatment Duration for Acute Otitis Media and Community-Acquired Pneumonia

Despite evidence supporting short treatment duration for acute otitis media and community-acquired pneumonia, many patients receive longer courses. The aim was to increase the proportion of short duration antibiotic therapy from 40% to 80% within 9 months in primary care, emergency department, and urgent care settings spanning three states.

This quality improvement initiative was conducted from June 2022 to March 2025. Interventions were implemented through seven plan-do-study-act cycles, including creation of a clinical pathway and electronic health record tools with subsequent enhancements, education, organizational support via physician incentivization and alignment with organizational goals, data sharing, gemba walks, and positive reinforcement. Change in the outcome (percentage of encounters receiving short duration therapy and the mean duration of therapy), process (percentage of encounters utilizing order panels) and balancing (treatment failure) measures over time were analyzed using statistical process control charts.

51,056 patients were included, with 18,040 patients in the baseline and 33,016 in the implementation phase. Short duration antibiotic therapy increased from 40% to 88% and improved across all race, ethnicity, and child opportunity indices (p<0.001). Minimal baseline disparities were further attenuated. Mean antibiotic duration decreased from 8 to 5.9 days, saving 42,141 cumulative antibiotic days. Treatment failure remained unchanged (5%, range 2.5%-7.8%).

Quality improvement methodology led to system-wide decrease in antibiotic duration across demographics in two common pediatric diagnoses. Aligning with organizational goals and data sharing proved to be effective strategies to promote large-scale practice change.

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