Intervention reduces antibiotic prescribing for pediatric respiratory infections by 7%
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A quality improvement intervention led to a 7% sustained reduction in antibiotic prescribing for pediatric acute respiratory tract infections at nearly two dozen U.S. practices, researchers reported in Pediatrics.
Extrapolated to all such visits nationally, that would represent a decrease of more than 1.5 million antibiotic prescriptions for children with acute respiratory tract infections, the researchers said.
“Pediatricians are continuing to find ways to avoid unnecessary antibiotics for their children, and we are learning how best to have those conversations with parents,” Matthew P. Kronman, MD, MSCE, associate professor of pediatric infectious diseases at Seattle Children’s Hospital, told Healio. “For clinicians, a take-home message is that even in busy outpatient primary care practices, there are interventions we can make that are both feasible and effective at improving how we use antibiotics.”
Antibiotic prescribing for acute respiratory tract infections accounts for more than 70% of all antibiotics prescribed for children in the ambulatory setting, and around one-third of antibiotic prescriptions for pediatric acute respiratory tract infections are inappropriate, Kronman and colleagues noted.
“Approximately 85% or more of all antibiotics given to children are prescribed in the outpatient setting, and about three-quarters of those antibiotics are for acute respiratory tract infections, which are the conditions we targeted in our study,” Kronman said. “Broad dissemination of this work has the possibility of having a large impact on unnecessary antibiotic prescribing for children in the United States.”
Kronman and colleagues conducted a stepped-wedge clinical trial from November 2015 to June 2018 that tested a prescribing intervention among 57 clinicians — 50 pediatricians and seven nurse practitioners — at 19 practices. The researchers randomly assigned the participants to four wedges.
The study included patients aged between 6 months and younger than 11 years with visits for acute otitis media, bronchitis, pharyngitis, sinusitis or upper respiratory infection.
“Clinicians received the intervention” — called the Dialogue Around Respiratory Illness (DART) quality improvement (QI) program — “as three program modules containing online tutorials and webinars on evidence-based communication strategies and antibiotic prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months,” Kronman and colleagues explained.
Their analysis included 29,762 patients who made 72,723 visits to a pediatrician for an acute respiratory tract infection.
According to the study, an intention-to-treat analyses showed a 7% decrease in the probability of antibiotic prescribing for acute respiratory tract infection overall between baseline and a 2- to 8-month postintervention period (adjusted RR = 0.93; 95% CI, 0.9-0.96).
The intervention led to decreases in second-line antibiotic prescriptions for streptococcal pharyngitis (aRR = 0.66; 95% CI, 0.5-0.87) and sinusitis (aRR = 0.59; 95% CI, 0.44-0.77).
However, prescribing for acute otitis media did not decrease (aRR = 0.93; 95% CI, 0.83-1.03), they reported.
All antibiotic prescribing for viral acute respiratory tract infections decreased by 40% (aRR = 0.6; 95% CI, 0.51-0.7).
In a related editorial, Rana F. Hamdy, MD, MPH, MSCE, director of the antimicrobial stewardship program at Children’s National Hospital in Washington, D.C., and Sophie E. Katz, MD, assistant professor of pediatrics at Vanderbilt University Medical Center, said Kronman and colleagues “seem to recognize that clinicians are adult learners, and they combine interventions to implement these adult learning theory tenets to improve appropriate antibiotic prescribing.”
“Combining interventions to address the multiple factors contributing to unnecessary antibiotic prescribing, [including] communications training, best practices training, and feedback reports, effectively reduced antibiotic prescribing for acute respiratory tract infections and might lead to sustained improvement in appropriate antibiotic prescribing when providers are engaged in training,” they wrote.
References:
- Hamdy RF. Pediatrics. 2020:doi:10.1542/peds.2020-012922.
- Kronman MP, et al. Pediatrics. 2020:doi:10.1542/peds.2020-0038.
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