Effect of an Antibiotic Stewardship Program on Antibiotic Choice, Dosing, and Duration in Pediatric Urgent Care

Background: Antibiotic stewardship programs (ASPs) have been shown to reduce antibiotic overuse with improved patient outcomes, particularly in inpatient setting. Most antibiotics are prescribed in the outpatient setting. Acknowledging outpatient antibiotic overuse and the impact of ASP, the Center for Disease Control and Prevention, the American Academy of Pediatrics and the Pediatric Infectious Disease Society identified high-quality antibiotic prescribing practices as an important target for outpatient ASPs

Methods: We reviewed all encounters at 4 freestanding PUC centers within our organization of patients >60 days and <18 years with a discharge diagnosis of acute otitis media (AOM), group A streptococcal (GAS) pharyngitis, community acquired pneumonia (CAP), urinary tract infection (UTI), cellulitis, abscess, and animal bite who received systemic antibiotics between July 2017 and December 2020. We excluded patients who were transferred, admitted, or had a concomitant diagnosis that required systemic antibiotics. We used established national guidelines to determine appropriateness of antibiotic choice, dose, and duration for each diagnosis. Pearson’s chi-square test was used to compare appropriate prescribing (choice, dose, and duration) between pre-implementation of our outpatient ASP (July 2017 – July 2018) and post-implementation periods (August 2018 -forward). Annotated monthly run charts evaluated improvement over time.

Results: We included 35,915 encounters during the study period. Appropriate antibiotic agent improved in AOM (75.8% to 77.2%; p=0.03), UTI (74.9% to 89.5%; p<0.001), cellulitis (70.5% to 75.1%; p=0.02) and abscess (53.6% to 67.7%; p<0.001) following implementation of our ASP. Excluding GAS pharyngitis, all diagnoses had improvement in appropriate duration (p < 0.001). Appropriate dosing improved for AOM (75.7% to 81.6%; p<0.001), UTI (34.9% to 42.9%; p=0.01) animal bites (37.1% to 45.6%; p=0.048), and cellulitis (28.0% to 42.3%; p<0.001).

Conclusion: Implementation of an outpatient ASP improved prescribing patterns for choosing the appropriate agent, duration, and dose for many common pediatric infections in our PUC setting. Future work will focus on identifying additional opportunities to improve prescribing practices when antibiotics are indicated.