Restricted accessResearch articleFirst published online 2019-10
Impact of an Antibiotic Stewardship Program on Antibiotic Prescription for Acute Respiratory Tract Infections in Children: A Prospective Before-After Study
We assessed the effectiveness of an antibiotic stewardship program (ASP) on antibiotic prescriptions for acute respiratory tract infection (ARTI) in a medical school. Our ASP included delivering an antibiotic use guideline via e-mail and LINE (an instant messaging app) to faculty staff, fellows, and residents, and posting of the guideline in examination rooms. Medical records of pediatric patients diagnosed with ARTI were reviewed to assess the appropriateness of antibiotic prescription. ASP could increase the rate of appropriateness from 78% (1979 out of 2553 visits) to 83.4% (2449 out of 2935 visits; P < .001). The baseline of appropriateness was higher in residents (95%) compared with fellows (82%) and faculty staff (75%). The ASP significantly increased the appropriateness only in faculty staff, especially in semiprivate clinics (75% to 83%, P < .001). In conclusion, our ASP increased appropriateness of antibiotic prescriptions for ARTI, with the greatest impact among faculty staff in semiprivate clinics.
Fleming-DutraKEHershALShapiroDJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315:1864-1873.
2.
HershALShapiroDJPaviaATShahSS.Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128:1053-1061.
3.
NyquistACGonzalesRSteinerJFSandeMA.Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998;279:875-877.
4.
GonzalesRMaloneDCMaselliJHSandeMA.Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis. 2001;33:757-762.
5.
SteinmanMALandefeldCSGonzalesR.Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. JAMA. 2003;289:719-725.
6.
NashDRHarmanJWaldERKelleherKJ.Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Arch Pediatr Adolesc Med. 2002;156:1114-1119.
7.
McCaigLFBesserREHughesJM.Antimicrobial drug prescription in ambulatory care settings, United States, 1992-2000. Emerg Infect Dis. 2003;9:432-437.
8.
RocaIAkovaMBaqueroF, et al. The global threat of antimicrobial resistance: science for intervention. New Microbes New Infect. 2015;6:22-29.
9.
SpinksAGlasziouPPDel MarCB.Antibiotics for sore throat. Cochrane Database Syst Rev. 2013;(11):CD000023.
10.
AlbrichWCMonnetDLHarbarthS.Antibiotic selection pressure and resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerg Infect Dis. 2004;10:514-517.
11.
SumpraditNChongtrakulPAnuwongK, et al. Antibiotics smart use: a workable model for promoting the rational use of medicines in Thailand. Bull World Health Organ. 2012;90:905-913.
12.
GerberJSPrasadPAFiksAG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA. 2013;309:2345-2352.
13.
WelschenIKuyvenhovenMMHoesAWVerheijTJ.Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial. BMJ. 2004;329:431.
14.
SabuncuEDavidJBernede-BauduinC, et al. Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Med. 2009;6:e1000084.
15.
RautakorpiUMHuikkoSHonkanenP, et al; MIKSTRA Collaborative Study Group. The Antimicrobial Treatment Strategies (MIKSTRA) program: a 5-year follow-up of infection-specific antibiotic use in primary health care and the effect of implementation of treatment guidelines. Clin Infect Dis. 2006;42:1221-1230.
16.
ShulmanSTBisnoALCleggHW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55:1279-1282.
17.
ChowAWBenningerMSBrookI, et al; Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54:e72-e112.
18.
American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113:1451-1465.
19.
ZhangJYuKF.What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690-1691.
20.
SyahroelRAlkamarADjamalAAMachmudR.Clinical predictors of childhood streptococcal pharyngitis. Paediatrica Indonesiana. 2008;48:114-119. doi:10.14238/pi48.2.2008.114-9
21.
TreebupachatsakulPTiengrimSThamlikitkulV.Upper respiratory tract infection in Thai adults: prevalence and prediction of bacterial causes, and effectiveness of using clinical practice guidelines. J Med Assoc Thai. 2006;89:1178-1186.
22.
LinMHChangPFFongWKYenCWHungKLLinSJ.Epidemiological and clinical features of group A Streptococcus pharyngitis in children. Acta Paediatr Taiwan. 2003;44:274-278.
23.
ShaikhNLeonardEMartinJM.Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126:e557-e564.
24.
ArnoldSRStrausSE.Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005;(4):CD003539.
25.
BoonyasiriAThamlikitkulV.Effectiveness of multifaceted interventions on rational use of antibiotics for patients with upper respiratory tract infections and acute diarrhea. J Med Assoc Thai. 2014;97(suppl 3):S13-S19.
26.
RazonYAshkenaziSCohenA, et al. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. J Antimicrob Chemother. 2005;56:937-940.
27.
JenkinsSGFarrellDJ.Increase in pneumococcus macrolide resistance, United States. Emerg Infect Dis. 2009;15:1260-1264.
28.
BergmanMHuikkoSHuovinenPPaakkariPSeppalaH; Finnish Study Group for Antimicrobial Resistance (FiRe Network). Macrolide and azithromycin use are linked to increased macrolide resistance in Streptococcus pneumoniae. Antimicrob Agents Chemother. 2006;50:3646-3650.
29.
BergmanMHuikkoSPihlajamakiM, et al; Finnish Study Group for Antimicrobial Resistance (FiRe Network). Effect of macrolide consumption on erythromycin resistance in Streptococcus pyogenes in Finland in 1997-2001. Clin Infect Dis. 2004;38:1251-1256.
30.
PhaffSJTiddensHAVerbrughHAOttA.Macrolide resistance of Staphylococcus aureus and Haemophilus species associated with long-term azithromycin use in cystic fibrosis. J Antimicrob Chemother. 2006;57:741-746.
31.
ChanGCTangSF.Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia. Singapore Med J. 2006;47:266-270.
32.
Lopez-VazquezPVazquez-LagoJMFigueirasA.Misprescription of antibiotics in primary care: a critical systematic review of its determinants. J Eval Clin Pract. 2012;18:473-484.
33.
TengCL.Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: a brief review. Malays Fam Physician. 2014;9:18-25.
34.
ParsonsHM.What happened at Hawthorne? New evidence suggests the Hawthorne effect resulted from operant reinforcement contingencies. Science. 1974;183:922-932.
35.
Mangione-SmithRElliottMNMcDonaldLMcGlynnEA.An observational study of antibiotic prescribing behavior and the Hawthorne effect. Health Serv Res. 2002;37:1603-1623.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
