Proposed metrics to benchmark antibiotic prescribing in pediatric outpatient settings

Published:September 04, 2021DOI:


      • Current national metrics of pediatric outpatient antibiotic prescribing are limited.
      • This article outlines the advantages and challenges of available prescribing metrics.
      • Quantitative measures are easy to extract and bypass diagnosis selection bias.
      • Qualitative measures capture antibiotic appropriateness and improvement targets.
      • We propose three high-impact metrics for pediatric outpatient antibiotic prescribing.
      Metrics to track and compare outpatient pediatric antibiotic prescribing are needed to improve antibiotic use and prevent unwanted consequences of antibiotic overuse. We have considered the impact and feasibility of available metrics and propose select high-priority measures for electronic reporting of pediatric outpatient antibiotic use. Streamlined use of antibiotic prescribing metrics will allow for national benchmarking, monitoring and identification of targets and goals for improvement.

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        • King LM
        • Bartoces M
        • Fleming-Dutra KE
        • Roberts RM
        • Hicks LA.
        Changes in US outpatient antibiotic prescriptions from 2011-2016.
        Clin Infect Dis. 2020; 70: 370-377
        • Bailey LC
        • Forrest CB
        • Zhang P
        • Richards TM
        • Livshits A
        • DeRusso PA.
        Association of antibiotics in infancy with early childhood obesity.
        JAMA Pediatr. 2014; 168: 1063-1069
        • Hersh AL
        • King LM
        • Shapiro DJ
        • Hicks LA
        • Fleming-Dutra KE
        Unnecessary antibiotic prescribing in US ambulatory care settings, 2010-2015.
        Clin Infect Dis. 2021; 72: 133-137
        • Fleming-Dutra KE
        • Hersh AL
        • Shapiro DJ
        • et al.
        Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011.
        JAMA. 2016; 315: 1864-1873
        • Zetts RM
        • Stoesz A
        • Smith BA
        • Hyun DY.
        Outpatient antibiotic use and the need for increased antibiotic stewardship efforts.
        Pediatrics. 2018; : 141
        • Gerber JS
        • Jackson MA
        • Tamma PD
        • Zaoutis TE
        • Diseases AAPCoI, Pediatric Infectious Diseases S.
        Policy statement: antibiotic stewardship in pediatrics.
        J Pediatric Infect Dis Soc. 2021; 10: 641-649
      1. Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core elements of outpatient antibiotic stewardship. 2016.

        • NewsCAP
        Joint Commission issues antimicrobial stewardship requirements for ambulatory health care.
        Am J Nurs. 2019; 119: 13
        • Newland JG
        • Gerber JS
        • Kronman MP
        • et al.
        Sharing antimicrobial reports for pediatric stewardship (SHARPS): a quality improvement collaborative.
        J Pediatric Infect Dis Soc. 2018; 7: 124-128
        • Versporten A
        • Gyssens IC
        • Pulcini C
        • et al.
        Metrics to assess the quantity of antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure.
        J Antimicrob Chemother. 2018; 73 (vi59-vi66)
        • Kronman MP
        • Gerber JS
        • Grundmeier RW
        • et al.
        Reducing antibiotic prescribing in primary care for respiratory illness.
        Pediatrics. 2020; : 146
        • Guzik J
        • Patel G
        • Kothari P
        • Sharp M
        • Ostrowsky B
        • Team UHFOAC
        Antibiotic prescribing for acute respiratory infections in New York City: a model for collaboration.
        Infect Control Hosp Epidemiol. 2018; 39: 1360-1366
        • Thilly N
        • Pereira O
        • Schouten J
        • Hulscher ME
        • Pulcini C.
        Proxy indicators to estimate appropriateness of antibiotic prescriptions by general practitioners: a proof-of-concept cross-sectional study based on reimbursement data, north-eastern France 2017.
        Euro Surveill. 2020; : 25
        • Chua KP
        • Fischer MA
        • Linder JA.
        Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
        BMJ. 2019; 364: k5092
        • Spellberg B
        • Rice LB.
        Duration of antibiotic therapy: shorter is better.
        Ann Intern Med. 2019; 171: 210-211
        • Committee on Infectious Diseases
        System-based treatment table.
        (editors)in: Kimberlin DW Barnett ED Lynfield R Sawyer MH Red Book 2021-2024 Rerport of the Committee on Infectious Diseases. 32 ed. American Academy of Pediatrics, Itasca, IL2021: 990-1003