“Antibiotic Stewardship” Program Helps Pediatricians Cut Off-Guideline Antibiotic Use

This needs to spread across the medical profession and across the nation.

A program of education and feedback for pediatricians cut inappropriate antibiotic use by about half, a researcher reported here.

In a cluster-randomized trial, the off-guideline use of broad-spectrum antibiotics for acute respiratory infections fell 48% in nine practices that got the intervention, according to Jeffrey Gerber, MD, of the Children’s Hospital of Philadelphia.

In contrast, the use of broad-spectrum drugs in nine control practices fell by 18%, Gerber told reporters at the IDWeek meeting here.

While so-called antibiotic stewardship programs have been successful in hospitals, Gerber said, most antibiotics are prescribed in an outpatient setting, especially for children.

“It made sense to see if we could extend some of these principles to the outpatient setting,” Gerber said.

The Children’s Hospital of Philadelphia, he noted, is associated with 29 pediatric practices that share a common electronic health records system. He and colleagues recruited 18 of them, including 174 clinicians, to take part in the trial.

Practices in the intervention arm got an education session with Gerber or a colleague to discuss guidelines for three diseases – sinusitis, group A streptococcal pharyngitis, and pneumonia – that are best treated, according to guidelines, with narrow-spectrum drugs.