Outpatient Antibiotic Stewardship: Can It Work?

Deborah Lehman, MD

Education followed by audit and feedback improved adherence to prescribing guidelines in outpatient pediatric settings.

Antibiotic stewardship programs improve antibiotic administration practices and decrease antibiotic resistance rates in hospitalized patients. Successful programs utilize guidelines for antibiotic use and provide direct feedback to prescribing physicians. Antibiotic stewardship has focused on inpatient prescribing, but most antibiotic prescribing occurs in outpatients. To examine the effect of a pediatric outpatient stewardship intervention on antibiotic prescribing for acute respiratory tract infections (sinusitis, streptococcal pharyngitis, pneumonia, and viral infections), investigators randomized 18 pediatric practices (162 physicians) in a large primary care network to an educational session followed by regular audit and feedback or no intervention. Diagnoses were determined by ICD-9 codes, and antibiotic use by prescriptions recorded in electronic medical records.

During the year after initiation of the intervention, broad-spectrum antibiotic prescriptions decreased by 12.5% in the intervention group and 5.8% in the control group. The most significant reduction was in broad-spectrum prescribing for treatment of pneumonia (from 16% to 4% in the intervention group vs. 17% to 16% in the control group) and sinusitis (from 39% to 19% vs. 40% to 34%). Broad-spectrum prescribing for streptococcal pharyngitis and viral infections remained low.

CITATION(S):

Gerber JS et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: A randomized trial. JAMA 2013 Jun 12; 309:2345.