A new study suggests that educating pediatricians in their offices, and auditing their prescription patterns, encourages them to choose more appropriate antibiotics for children with common respiratory infections.
“Although much research has focused on improving how hospitals use antibiotics, there have been few studies of interventions in outpatient settings, where the vast majority of antibiotic use occurs,” said study leader Jeffrey S. Gerber, MD, PhD, an infectious diseases specialist at Children’s Hospital. “We focused on increasing appropriate antibiotic prescribing in primary care practices.”
Dr. Gerber and colleagues recently published their study of an “antimicrobial stewardship” program in Journal of the American Medical Association. Antimicrobial stewardship usually involves prospective audits of prescription patterns — comparing the prescription for a given diagnosis to the current recommendations of professional. For this study, stewardship also included personalized, private feedback reports to practitioners, advising them of whether their prescriptions followed current recommendations.
The study concentrated on whether the pediatricians prescribed narrow-spectrum antibiotics, as recommended, or broad-spectrum antibiotics for acute bacterial respiratory infections such as pneumonia, acute sinusitis, and streptococcal pharyngitis (or “strep throat”). All are common conditions for which children receive antibiotics.
The study team randomized 18 pediatricians’ practices in CHOP’s primary care network in New Jersey and Pennsylvania into two groups — one that received the intervention (an hour-long clinician-education session at the practice office, followed by audit and feedback of antibiotic prescribing) and a control group that did not receive the educational session, audit and feedback.
The study encompassed nearly 1.3 million office visits by some 185,000 patients to 162 clinicians over a study period of 32 months, from 2008 to 2011.
Among the intervention practices, broad-spectrum antibiotic prescribing decreased from 26.8 percent to 14.3 percent, or nearly half, compared to a decrease from 28.4 percent to 22.6 percent in the control group. For children with pneumonia, the inappropriate broad-spectrum prescriptions declined by 75 percent among practices receiving the intervention.