October 18, 2012 | 6
Antibiotics have been a boon to modern pediatric medicine—transforming many previously fatal childhood ailments into mere inconveniences. But these revolutionary treatments are not a cure-all. In fact, many common pediatric illnesses, including many ear and respiratory infections, fail to respond to antibiotics. And over-prescription of these meds—especially broad-spectrum antibiotics—is not only costly; it can also contribute to the growing and disconcerting trend of antibiotic resistance and can precipitate further health issues for some children who might have an adverse reaction to the medications.
A new study, however, shows that a simple education program for pediatricians can cut in half the number of inappropriate antibiotic prescriptions.
A total of 174 clinicians from 18 different practices were randomly assigned to either a control group (that was informed that a study was being conducted) or an intervention group that received a short educational session on current pediatric antibiotic prescription guidelines as well as a quarterly report on their individual prescribing stats. The education program focused on pneumonia, sinus infections and strep throat—respiratory infections that often do not require broad-spectrum antibiotics yet are often cited as the reason for prescribing them. The study lasted for a year and covered more than 1.4 million office visits. Prescriptions were tracked via electronic health records.
In the three months before the trial started, about 28 percent of the 185,212 children in the patient population were prescribed antibiotics that the researchers later judged as inappropriate. By the end of the trial, the group of clinicians who received the additional prescription info had cut their erroneous prescription rate in half (to about 14 percent). The largest drop was for pneumonia: initially, antibiotics were prescribed incorrectly in about 16 percent of the cases for pneumonia, but after the intervention, doctors in the education group cut that to just 4 percent.
Inappropriate prescriptions for the three respiratory ailments also declined in the control group during the study period from 33 percent to 24 percent, possibly because they knew they were being included in a study.
“The impact of the intervention group was much better than we thought it would be,” Jeffery Gerber, an assistant professor of pediatrics at Children’s Hospital of Philadelphia and collaborator on the study, said in a prepared statement. “It shows that getting people up to speed and providing simple reminders are helpful. It also shows that you can leverage electronic health records to put together a relatively low-maintenance system to improve prescribing.”
The findings were presented October 18 at IDWeek, a meeting aimed at highlighting progress in the fight against infectious diseases, in San Diego.
“The intervention isn’t complicated or high-tech, so it should be scalable to large populations, where it could make a big difference in slowing resistance and preventing the complications of inappropriate antibiotic use,” Daniel Diekema, director of the Division of Infectious Diseases at the University of Iowa, who was not involved in the new research, said in a prepared statement.