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Intervention improved antibiotic use for bacterial respiratory tract infections
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Clinician education along with personalized audit and feedback about antibiotic prescribing improved adherence to prescribing guidelines for bacterial acute respiratory tract infections; however, it did not affect antibiotic prescribing for viral infections, according to recent study findings published in JAMA.
“Unnecessary prescribing for [acute respiratory tract infections] is well documented and has been declining,” Jeffrey S. Gerber, MD, PhD, and colleagues wrote. “However, inappropriate prescribing also occurs for bacterial [acute respiratory tract infections], particularly when off-guideline antibiotics are used to treat infections from which narrow-spectrum antibiotics are indicated and recommended.”
The cluster randomized trial included 18 primary care practices (162 clinicians) in Pennsylvania and New Jersey. Researchers examined rates of off-guideline antibiotic prescribing for bacterial acute respiratory tract infections (ARTIs) and viral ARTIs for 1 year following intervention.
Jeffrey S. Gerber
Researchers found that off-guideline antibiotic prescribing decreased from 26.8% to 14.3% among the intervention group compared with 28.4% to 22.6% among the control group.
In children with pneumonia, off-guideline prescribing decreased from 15.7% to 4.2% among the intervention group compared with 17.1% to 16.3% among the control group. Prescribing for acute sinusitis also decreased among the intervention group from 38.9% to 18.8% compared with 40% to 33.9% in the control group.
However, researchers found that off-guideline prescribing was uncommon at baseline for streptococcal pharyngitis but decreased some (4.4% to 3.4%, intervention group vs. 5.6% to 3.5%, control group). The same was true for viral infections (7.9% to 7.7%, intervention group vs. 6.4% to 4.5%, control group).
“In conclusion, through clinician education coupled with audit and feedback of prescribing, we were able to significantly improve antibiotic use for children with bacterial ARTIs,” researchers wrote. “This targeted application of antimicrobial stewardship principles to the ambulatory setting has the potential to affect the most common indications for antibiotic use.”
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Disclosure: See study for a full list of disclosures.