Reducing Antibiotic Use in Kids: An Intervention That Works?

Jeffrey S. Gerber, MD, PhD


September 16, 2013

Editorial Collaboration

Medscape &

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My name is Jeff Gerber, and I am from the Division of Infectious Diseases at the Children's Hospital of Philadelphia. I wanted to talk to you today about a study that we recently published in JAMA looking at antibiotic prescribing by primary care pediatricians.[1] As many of you know, we have seen a dramatic increase in broad-spectrum antibiotic prescribing for both children and adults, and at the same time, an increase in resistant pathogens in the community, including organisms such as methicillin-resistant Staphylococcus aureus (MRSA).

Taking advantage of our large practice-based research network, we designed a cluster randomized controlled trial [to examine] education and audited feedback of antibiotic prescribing by primary care pediatricians. Because pediatricians are very busy and might not have time to keep up with all the latest data and latest recommendations, we tried to distill down the latest recommendations of antibiotic prescribing for common pediatric infections, including pneumonia, sinusitis, and Group A strep pharyngitis. Our intervention occurred in 18 practices, and 9 practices received an onsite, 1-hour education session and refresher course on these prescribing guidelines. Over a 12-month period, they received a summary of their antibiotic prescribing based on these recommendations. The other 9 practices received no intervention.

What we found is a significant reduction in broad spectrum or off-guideline antibiotic prescribing for these 3 common conditions, including a 75% reduction in broad-spectrum or off-guideline antibiotic prescribing for children with pneumonia. This suggests that a simple education session with audited feedback of antibiotic prescribing can effectively improve antibiotic prescribing in the outpatient setting, where a majority of antibiotic use occurs.

Future studies will look at the durability of this effect and will also compare clinical outcomes between children who are in the intervention and those who did not receive the intervention.