Optimizing Antibiotic Duration for Pneumonia and Sinusitis in the Pediatric Emergency Department

Updates to national and international guidelines now recommend shortening antibiotic durations to 3 to 5 days for uncomplicated community-acquired pneumonia (CAP) and 5 to 7 days for acute bacterial rhinosinusitis (ABRS). We aimed to increase the percentage of children discharged home from the emergency department with CAP or ABRS who were treated with an optimal antibiotic duration from 13% to 70% by July 2025.

We assembled a multidisciplinary team and used quality improvement tools, including cause-and-effect analysis, driver diagram, and prioritization matrix, to identify impactful interventions. We also surveyed prescriber comfort with shorter antibiotic durations. Plan-Do-Study-Act cycles included implementing new clinical pathways (CP), electronic health record (EHR) updates, and educating prescribers. Our outcome metric was the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics included use of CP Quick Response codes and CAP "Quick-Discharge" order sets. Balancing metric was the number of return visits with the same diagnosis within 14 days.

We saw shifts in the outcome metric center line in August 2023, February 2024, and November 2024 from 13.1% to 64.8%. These changes primarily reflected CAP duration because it was the more common diagnosis, although ABRS short antibiotic durations showed similar improvement during this time frame. Process metrics showed an increase over time. There was no change in balancing metric.

We significantly improved antibiotic prescription durations for CAP and ABRS through CP changes, EHR updates, prescriber education and feedback, and resource distribution.