Reducing Antibiotic Use by Implementation of Stewardship in Primary and Urgent Care
- Conditions
- Acute Otitis Media (AOM)Strep PharyngitisCommunity Acquired Pneumonia (CAP)Sinusitis
- Registration Number
- NCT07217002
- Lead Sponsor
- Children's Hospital of Philadelphia
- Brief Summary
The goal of this project is to reduce unnecessary antibiotic use for children with ARTIs (Acute Respiratory Tract Infections) by implementing "outpatient antibiotic stewardship" across the Children's Hospital of Philadelphia (CHOP) Primary and Urgent Care Network to:
1. Reduce unnecessary antibiotic prescribing for the most common infections in children.
2. Reduce unnecessary a) broad-spectrum and b) longer-course antibiotic therapy for ear infections, Strep throat, sinus infections, and pneumonia.
- Detailed Description
Children often receive antibiotics for acute respiratory tract infections (ARTIs) which are caused by viruses, such as the common cold. However, antibiotics cannot treat viruses. Using antibiotics when they are not needed can cause harm - including side effects like rashes, vomiting and diarrhea - and can make it harder for the antibiotics to work when they are needed to treat infections caused by bacteria. For ARTIs caused by bacteria - like ear infections, sinus infections, strep throat or pneumonia - narrow-spectrum antibiotics are the best choice. This is because narrow-spectrum antibiotics target only the harmful bacteria, while "broad-spectrum" antibiotics target additional bacteria than can be helpful for the body. For many of these infections, it is also better to use shorter courses of antibiotics (such as five days) instead of longer courses (such as 10 days). Research studies have shown clearly that shorter courses and narrow-spectrum antibiotics cure infections just as well as longer courses and broad-spectrum antibiotics, but with fewer side effects.
Over two years, the project team will use proven strategies to ensure that children get the right antibiotics for the right amount of time. During this time, all pediatric doctors and nurse practitioners in this large, diverse network will receive:
1. Online education about proper antibiotic prescribing.
2. Regular feedback on how their antibiotic prescribing compares to peers and to professional guidelines.
3. Tools in the electronic health record to make it easy to prescribe the right antibiotics.
4. Yearly, live hybrid in-person and online educational sessions
The project team will determine how well this program works by measuring:
1. How often antibiotics are prescribed to children with ARTIs.
2. How often children with bacterial ARTIs (ear infections, sinus infections, strep throat and pneumonia) get the right antibiotic choice and right number of antibiotic days.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 420
Not provided
Not provided
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Antibiotic Prescribing Rates for Acute Respiratory Tract Infections (ARTIs) From start of implementation ramp up period to end of year 2 implementation ARTIs as measured by overall rates of prescribing an antibiotic during clinic visits for an acute respiratory tract infection (URI) diagnosis, including both bacterial and viral URIs using the EHR. Goal is that antibiotics are prescribed at 40% or fewer ARTI visits. The optimal proportion of ARTI visits that should be associated with an antibiotic prescription is unknown. Baseline prescribing rates for antibiotics in the Network ranges from 34-61%. The target 40% rate is currently achieved by 10% of our practices with the lowest antibiotic prescribing.
Change in overall optimal antibiotic prescribing rates for all bacterial ARTI encounters From start of implementation ramp up period to end of year 2 implementation Changing overall antibiotic prescribing rates as measured by a composite of 1) narrow antibiotic selection and 2) shortest effective duration as a proportion of all antibiotics prescribed for each of the target diagnoses: Acute otitis media, Group A streptococcal pharyngitis, Acute sinusitis, and Pneumonia using EHR (electronic health record) data. This metric combines both narrow-spectrum antibiotic choice and optimal durations of therapy to comprehensively evaluate optimal antibiotic prescribing. At least 90% of antibiotics prescribed for ARTI are for optimal short duration and narrow spectrum antibiotics
Broad- versus Narrow-Spectrum Antibiotic Prescribing From start of implementation ramp up period to end of year 2 implementation Broad vs. Narrow-Spectrum antibiotic prescribing as measured by rates of broad-spectrum antibiotics as a proportion of all antibiotics prescribed within each of these diagnoses using the EHR (electronic health record):
* acute otitis media
* Group A streptococcal pharyngitis
* acute sinusitis
* pneumonia At least 90% of antibiotics prescribed for ARTI are for optimal narrow spectrum antibiotics.Shortest Effective Duration Antibiotic Prescribing From start of implementation ramp up period to end of year 2 implementation Shortest effective duration measured by rates of prescribing the shortest effective duration of antibiotics as a proportion of all antibiotics prescribed within each of these diagnoses:
* acute otitis media
* Group A streptococcal pharyngitis
* acute sinusitis
* pneumonia At least 90% of antibiotics prescribed for ARTI are for the shortest effective duration of antibiotics. Optimizing durations of therapy will reduce overall antibiotic days and, therefore, decrease the overall antibiotic burden for children with ARTIs.
- Secondary Outcome Measures
Name Time Method Treatment failure or modification 14 days 14 days Treatment failure measured at 14 days if there is in person or telephone contact with the same ARTI diagnosis with receipt of any systemic ARTI-directed antibiotic found in the EHR. The target is for no increase in treatment failure.
Antibiotic-associated adverse events (AEs) within 7 days of completing antibiotics From index visit to 7 days of completing antibiotics AEs as measured by in person or telephone contact for diarrhea, candidiasis, non-candidal rash, other or unspecified allergic reaction, other or unspecified adverse event, and vomiting using the EHR.
Trial Locations
- Locations (1)
Children's Hospital of Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Children's Hospital of Philadelphia🇺🇸Philadelphia, Pennsylvania, United States