Antibiotic Education Improves Prescription Practices

A recent study of an “antimicrobial stewardship” program by Children’s Hospital researchers found that offering pediatricians education, and auditing their prescription patterns, can encourage them to choose more appropriate antibiotics for children with common respiratory infections. The study encompassed nearly 1.3 million office visits by some 185,000 patients.

“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 the study’s leader, CHOP infectious disease specialist Jeffrey S. Gerber, MD, PhD. “We focused on increasing appropriate antibiotic prescribing in primary care practices.”

Dr. Gerber and his team published their findings in the Journal of the American Medical Association.

Antimicrobial stewardship usually involves prospective audits of prescription patterns — comparing the prescription for a given diagnosis to the current recommendations of professional organizations, such as the American Academy of Pediatrics, said Dr. Gerber. This study also included personalized, private reports to practitioners, advising them of whether their prescriptions followed current recommendations.

The researchers randomized 18 pediatricians’ practices in CHOP’s primary care network in New Jersey and Pennsylvania into two groups — one that received the intervention (an hour-long clinician 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.

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

Future studies should investigate how applicable these findings are to other health systems, Dr. Gerber said. Nonetheless, he noted “our findings suggest that extending this type of intervention to the outpatient setting may have important health benefits in children.”