Optimal Antibiotic Use Wanes Without Clinician Feedback

Clinicians must select antibiotics carefully, in order to maintain their effectiveness and limit antimicrobial resistance. Judicious use of antibiotics has important health benefits for children especially because they are prescribed so frequently, usually for outpatient acute respiratory tract infections.

A previously reported study of an antimicrobial stewardship program conducted by researchers at The Children’s Hospital of Philadelphia found that offering pediatricians education, auditing their prescription patterns, and providing feedback can encourage them to choose the most appropriate antibiotics. Jeffrey S. Gerber, MD, PhD, a CHOP infectious diseases specialist, gave an update to this study at the IDWeek 2014 meeting held in Philadelphia Oct. 8-12. He reported that reductions in prescribing rates for broad-spectrum antibiotics faltered when the researchers stopped providing antibiotic prescribing audit and feedback to clinicians in the intervention group.

“These data suggest that audit and feedback was a vital element of this intervention and that antimicrobial stewardship requires continued, active efforts to sustain initial improvements in prescribing,” Dr. Gerber and colleagues wrote in a research letter to the Journal of the American Medical Association that was released early to coincide with IDWeek.

In the cluster randomized trial, nine community-based pediatric primary care practices received the combined intervention of education plus prescribing audit and feedback, and nine practices received no intervention. Among the intervention practices, broad-spectrum antibiotic prescribing decreased from 26.8 percent to 14.3 percent, or nearly half, compared to a decrease from 28.4 percent to 22.6 percent in the control group.

At the end of the intervention, the researchers discontinued antibiotic prescribing audit and feedback to clinicians, but the study team extended their observation period for 18 months. Their latest data showed that prescribing of broad-spectrum antibiotics increased over time and reverted to above-baseline levels: 27.9 percent in the intervention group and 30.2 percent in controls.

“Our findings suggest that extending antimicrobial stewardship to the ambulatory setting can be effective but should include continued feedback to clinicians,” the authors concluded in the JAMA letter.