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Impact of an antibiotic stewardship program on antibiotic choice, dosing, and duration in pediatric urgent cares

Published:August 05, 2022DOI:https://doi.org/10.1016/j.ajic.2022.07.027

      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 antimicrobial stewardship program had a significant impact on antibiotic prescribing.
      • We saw the biggest improvement in appropriate antibiotic dosing and duration.
      • Antimicrobial stewardship programs 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 χ² test compared appropriate prescribing before ASP implementation (July 2017-July 2018) and postimplementation (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 lines for appropriate agent, dose, and duration all underwent upward shifts. The most substantial changes were seen in antibiotic duration (63.2%-80.5%), and appropriate dose (64.6%-77%).

      Conclusions

      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

      Key words

      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)
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