Highlights
- •We assessed appropriate antibiotics for common infections in pediatric urgent cares.
- •We assessed rates of guideline-concordance for antibiotic agent, duration, and dosing.
- •Outpatient ASP had a significant impact on antibiotic prescribing.
- •We saw the biggest improvement in appropriate antibiotic dosing and duration.
- •ASPs positively influence the prescribing behaviors of outpatient clinicians.
Abstract
Background
: Many antimicrobial stewardship programs (ASPs) focus on decreasing unnecessary antibiotics.
We describe the impact of an outpatient ASP on choice, dose, and duration of antibiotics
when used for common infections in pediatric urgent care (PUC) centers.
Methods
: We reviewed encounters at 4 PUC centers within our organization for patients 6 months
to 18 years old with acute otitis media, group A streptococcal pharyngitis, community-acquired
pneumonia, urinary tract infection, and skin and soft tissue infections who received
systemic antibiotics. We determined appropriate antibiotic choice, dose, and duration
for each diagnosis. Pearson's chi-square test compared appropriate prescribing before
ASP implementation (July 2017 – July 2018) and post-implementation (August 2018 –
December 2020). Control charts trended improvement over time.
Results
: Our study included 35,917 encounters. The percentage of prescriptions with the recommend
agent at the appropriate dose and duration increased from a mean of 32.7% to 52.4%.
The center line for appropriate agent, dose, and duration all underwent upward shifts.
The most substantial changes were seen in antibiotic duration (63.2% to 80.5%), and
appropriate dose (64.6% to 77%).
Conclusion
: Implementation of an outpatient ASP improved prescribing patterns for choosing the
appropriate agent, duration, and dose for many common infections in our PUCs.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AAP (American Academy of Pediatrics), AOM (acute otitis media), ASP (antimicrobial stewardship program), CAP (community-acquired pneumonia), CDC (Centers for Disease Control and Prevention), GAS (group A streptococcal), ICD-10 (International Classification of Diseases 10th iteration), IDSA (Infectious Diseases Society of America), PUC (pediatric urgent care), SSTI (skin and soft tissue infection), UTI (urinary tract infection)To read this article in full you will need to make a payment
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© 2022 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
