Order set cuts antibiotic use for pediatric ear infections in half
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Key takeaways:
- An order set was created to automatically choose 5-day antibiotic courses for ear infections.
- The proportion of 5-day prescriptions rose from 3% before the intervention to 83% after.
An electronic health record order set that preselected shorter antibiotic courses for acute otitis media cut antibiotic use for pediatric ear infections in half, according to findings presented at IDWeek.
“We chose this topic because ear infections are a very common issue for children and are the leading reason for antibiotic prescriptions in kids,” Joana Dimo, DO, a doctoral fellow at the University of Colorado, said during a press conference. “Research supports that 75% of children get better on their own without any antibiotics, and when needed, short courses of just 5 days are as safe and effective as traditionally longer courses.”
Although the AAP published guidelines in 2013 recommending 5 to 7 days of antibiotics for nonsevere and uncomplicated pediatric ear infections, research published earlier this year showed that 75% of providers at two academic health systems were still prescribing 10-day courses for ear infections.
According to Dimo, the researchers noticed that providers at their institution were prescribing more antibiotics than they felt were necessary. In response, they created an electronic health record order set that preselected 5-day courses for all children older than 2 years who visited EDs and urgent care centers within the University of Colorado system.
“We chose a population of clinicians that work in a really fast-paced environment — emergency care and urgent care. Utilizing something like an order set, which we did, helps their flow of patient care,” Nicole Poole, MD, assistant professor of pediatric infectious diseases at the University of Colorado, said in the press conference.
Poole told Healio earlier this year that the “shorter is better” message — which emphasizes that shorter antibiotic durations are just as effective as longer courses for some infections — has been slow to reach pediatricians. Improved prescribing is one way that clinicians can help slow the development of antibiotic resistance.
“The goal is to help make the right thing the easy thing for our clinicians,” Poole said during the press conference.
Dimo and colleagues implemented the order set in April 2021. They reviewed patient visits that occurred between January 2019 and September 2023 to compare antibiotic prescription trends before and after the intervention.
The study included 34,324 patients aged 61 days to 18 years. The researchers found that the proportion of patients who were prescribed antibiotics rose from 88% in 2019 to 93% in 2023. Amoxicillin prescriptions decreased from 77% to 74%, with sharp drop in late 2022, likely due to the amoxicillin shortage, according to the researchers.
The proportion of patients receiving 5-day antibiotic courses rose from 3% to 83% during the study period. Dimo said overall antibiotic use was cut in half due to the increase in shorter courses.
“One of the great things about our project is that it utilizes the electronic health record ordering system — which is present in every institution — to implement these changes in antibiotic prescribing that we saw, and I think that makes it very reproducible in a wide variety of settings,” Dimo said. “It is not labor intensive, it is cost effective, and it can result in dramatic changes in antibiotic use.”
References:
- Dimo J, et al. Abstract 176. Presented at: IDWeek; Oct. 16-19, 2024; Los Angeles.
- Preset treatment orders improve antibiotic prescribing practices. Published Oct. 16, 2024. Accessed Oct. 16, 2024. [Provided prior to publication online.]
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Dimo J, et al. Abstract 176. Presented at: IDWeek; Oct. 16-19, 2024; Los Angeles.
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