1935. Effect of Antibiotic Duration Option Buttons in the Electronic Medical Record on Outpatient Antibiotic Prescribing in Pediatrics
Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall

Background: Most antibiotics for children are prescribed in the outpatient setting. Evidence-based recommendations for antibiotic duration for common infections are rare, and duration prescribing practices vary widely. Antibiotic stewardship interventions in ambulatory settings are labor intensive and difficult to implement.

Methods: In Feb. 2015, we introduced duration option buttons (DOBs) into the electronic medical record for antibiotic prescribing. Prescribers were provided DOBs with shorter duration options (≤ 10 days), without preferences or guidelines, but any duration could be manually entered. We then assessed antibiotic durations for 6 antibiotics prescribed during emergency room or outpatient visits. We compared antibiotic durations between the 3-year pre-intervention and 1-year post-intervention periods. Generalized estimating equation models were used to evaluate the effects of the intervention, time, setting, and medication. A spline term at the date of intervention was included in all models.

Results: Overall, between the pre-intervention period (20775 antibiotic courses) and the post-intervention period (6203 antibiotic courses), duration decreased by 0.2 days per antibiotic course (p=0.002). There was a highly significant 0.6 day per antibiotic course reduction for clindamycin [Fig. 1], and marginally significant intervention effects for trimethoprim-sulfamethoxazole (TMP-SMX; p=0.055) and cephalexin (p=0.061). Had the DOBs been instituted in 2012, we estimate saving 5668 antibiotic days ($72,833) for clindamycin, TMP-SMX, and cephelexin over the 4-year study period.

Conclusion: The simple provision of DOBs can lead to decreased antibiotic durations, and offer a low cost option to decrease antibiotic use in the outpatient setting.

Table 1. Effect of DOBs on antibiotic duration

Antibiotic

DOB (days)

Prescribed Duration (days)

Mean +/- SD

Estimate/Intervention effect (days)

p-value

Pre-I

Post-I

Amoxicillin

7,10

9.8 +/- 1.3

9.4 +/- 1.5

-0.04

0.358

Clindamycin

5,7

9.1 +/- 2.2

8.1 +/- 2

-0.60

<0.001

Cephalexin

5,7

8.4 +/- 2.5

7.9 +/- 2.6

-1.82

0.061

Cefdinir

7,10

9.7 +/- 2.2

9.4 +/- 2.5

+0.10

0.593

Fluoroquinolones

5,7

11.1 +/- 4.7

10.3 +/- 4.9

-0.13

0.926

TMP-SMX

5,7

9.9 +/- 4.6

8.6 +/- 4.5

-2.10

0.055

All

 

9.6 +/- 2

9.1 +/- 2.2

-0.20

0.002

 

Figure 1.

 

 

Marielle Fricchione, MD1, Hannah Palac, MS2, Daniel Healy, PharmD3, Rupal Patel, PharmD4, Larry Kociolek, MD1 and Sameer Patel, MD, MPH1, (1)Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (2)Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, (3)Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, (4)Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL

Disclosures:

M. Fricchione, None

H. Palac, None

D. Healy, None

R. Patel, None

L. Kociolek, None

S. Patel, None

<< Previous Abstract | Next Abstract

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.