The following is a summary of “Improving Antibiotic Prescribing for Children with Community-acquired Pneumonia in Outpatient Settings,” published in the June 2024 issue of Pediatrics by Daley et al.
This study evaluated whether a two-phase intervention improved antibiotic prescribing practices among non-hospitalized children with community-acquired pneumonia (CAP).
In a large healthcare organization, a phased intervention was launched to optimize antibiotic selection and duration for children aged 2 months to 17 years diagnosed with pneumonia. The first phase, initiated in September 2020, included clinician education and implementing a pneumonia-specific order set within the electronic health record (EHR). In October 2021, a second phase introduced further educational sessions and revisions to the order set. The intervention promoted using narrow-spectrum antibiotics, such as amoxicillin, as the primary treatment option in most cases. EHR data were analyzed to identify pneumonia cases and corresponding antibiotic prescriptions. Interrupted time series analyses compared antibiotic choices and durations across three periods: pre-intervention (January 2016 to early March 2020), post-phase-one (September 2020 to September 2021), and post-phase-two (October 2021 to October 2022).
A total of 3,570 cases of CAP were identified, with 3,246 cases pre-intervention, 98 post-phase-one, and 226 post-phase-two. The proportion of children receiving narrow-spectrum monotherapy significantly increased from 40.6% pre-intervention to 68.4% post-phase-one and 69.0% post-phase-two (p<0.001). Additionally, for children initially prescribed a narrow-spectrum antibiotic, the mean duration of therapy decreased from 9.9 days (SD 0.5 days) pre-intervention to 8.2 days (SD 1.9 days) post-phase-one and further to 6.8 days (SD 2.3 days) post-phase-two (p<0.001).
The two-phase intervention, incorporating educational initiatives and enhanced clinical decision support, was associated with sustained improvements in the choice and duration of antibiotic therapy among children with community-acquired pneumonia. These findings underscore the effectiveness of structured interventions in promoting evidence-based antibiotic use in outpatient settings, thereby potentially reducing the risks of antibiotic resistance, a significant concern in healthcare, and improving clinical outcomes for pediatric patients.
Source: sciencedirect.com/science/article/abs/pii/S0022347624002580
