Reporting Antibiotic Prescription Patterns Back to Providers Improves Adherence to IDSA Guidelines for Treatment of Streptococcal Pharyngitis and Outpatient Antibiotic Stewardship

Background: On Sep. 9, 2012 the IDSA released its “Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis,” with a goal of encouraging better outpatient antimicrobial stewardship. Cook Children’s Physician Network has integrated its 80 primary care pediatricians and mid-level providers through the AthenaNet® on-line electronic medical record with e-prescribing capability. Driven by an increase in urinary tract infections resistant to oral antibiotics among children in our community, we decided to inform our network providers of their prescription patterns for one of many common pediatric infections, streptococcal pharyngitis, while presenting to them a copy of the Guideline to see how that might effect antimicrobial stewardship.

Methods: Antibiotic prescriptions for Group A Streptococcal pharyngitis were tabulated by provider from Sep. 1, 2011 – Aug 31, 2012. On Oct. 5, 2012, the coded spreadsheet, the Guideline, and a cover letter discussing our network results, a need for better antibiotic stewardship, and each provider's key were mailed to each provider for review.  We characterized antibiotics as 1) the most narrow spectrum therapy (pen VK, Bicillin, amoxicillin), 2) an alternative first generation cephalosporin (cefadroxil, cephalexin), and 3) effective, but too broad for the purposes of antimicrobial stewardship (amoxicillin/clavulanate, azithromycin, cefaclor, cefdinir, cefixime, cefpodoxime, cefprozil, ceftibuten, cefuroxime, ciprofloxacin, clarithromycin, erythromycin), which we defined as our target for better stewardship. We compared the data for the subsequent 6 months.

Results:

Review Period	Total Prescriptions for Streptococal Pharyngitis	Most Narrow Spectrum Antibiotic (Penicillin or Amoxicilin)	First Generation Cephalosporin (cefadroxil, cephalexin)	Target for Better Antimicrobial Stewardship (All Other Effective Antibiotics)
Sep.1,2011-Aug.31,2012	23,345	10,178 (44%)	2,121 (9%)	10,916 (47%)
Oct.15,2012-Apr.15,2013	8,205	5,097 (62%)	837 (10%)	2,243 (27%)

Conclusion: Reporting of comparative antibiotic prescribing patterns to providers reduced network prescriptions for streptococcal pharyngitis that were effective, but too broad for the purposes of antimicrobial stewardship from 47 to 27% for 6 months. More feedback is planned.