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‘Stewardship Program’ Helps Pediatricians Limit Misuse of Antibiotics

Clinicians align prescribing with national guidelines (June 12)

As disease-causing microbes continue to develop resistance to commonly used antibiotics, public health experts have called for more selective use of these medicines. 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 the Children’s Hospital of Philadelphia. “We focused on increasing appropriate antibiotic prescribing in primary care practices.”

Gerber and his colleagues published their study of an “antimicrobial stewardship” program in the June 12 issue of the Journal of the American Medical Association.

Antimicrobial stewardship, said Gerber, usually involves prospective audits of prescription patterns — comparing the prescription for a given diagnosis to the current recommendations of professional organizations (in the current study, as issued by the American Academy of Pediatrics). 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 (“strep throat”). All are common conditions for which children receive antibiotics.

The study team randomized 18 pediatricians’ practices 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 involved nearly 1.3 million office visits by approximately 185,000 patients to 162 clinicians over a period of 32 months, from 2008 to 2011.

Among the intervention practices, broad-spectrum antibiotic prescribing decreased from 26.8% to 14.3%, or nearly half, compared with a decrease from 28.4% to 22.6% in the control group. For children with pneumonia, the inappropriate broad-spectrum prescriptions declined by 75% among practices receiving the intervention.

Sources: JAMA; June 12, 2013; and Children’s Hospital of Philadelphia; June 11, 2013.

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