Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness

Pediatrics. 2020 Sep;146(3):e20200038. doi: 10.1542/peds.2020-0038. Epub 2020 Aug 3.

Abstract

Background: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits.

Methods: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability.

Results: Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70).

Conclusions: This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.

Trial registration: ClinicalTrials.gov NCT02943551.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use*
  • Bronchitis / drug therapy
  • Bronchitis / virology
  • Chicago
  • Child
  • Child, Preschool
  • Communication
  • Confidence Intervals
  • Education, Distance / methods
  • Education, Distance / organization & administration*
  • Female
  • Humans
  • Inappropriate Prescribing / prevention & control*
  • Infant
  • Intention to Treat Analysis
  • Logistic Models
  • Male
  • Odds Ratio
  • Otitis Media / drug therapy
  • Outpatients
  • Pediatric Nursing / education
  • Pediatric Nursing / statistics & numerical data
  • Pediatricians / education
  • Pediatricians / statistics & numerical data
  • Pharyngitis / drug therapy
  • Pharyngitis / microbiology
  • Pharyngitis / virology
  • Primary Health Care*
  • Program Development
  • Quality Improvement
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / virology
  • Sinusitis / drug therapy
  • Streptococcal Infections / drug therapy

Substances

  • Anti-Bacterial Agents

Associated data

  • ClinicalTrials.gov/NCT02943551