Methods: CPs outlining standard of care for acute otitis media (AOM), group A streptococcus (GAS) pharyngitis and community acquired pneumonia (CAP) were developed in collaboration with Children’s Hospital of Philadelphia and implemented with accompanied training in the emergency department (ED) at the Department for Woman and Child Health of Padua, Italy on 1 October 2015. We collected data from children with AOM, GAS pharyngitis, and CAP from 10/15/2014-04/15/2015 (pre-intervention period) and 10/15/2015-04/15/2016 (post-intervention period). We assessed differences in timing, and breadth of spectrum of antibiotic prescribing using chi-square, t-tests and standard process control p-chart. Amoxicillin-clavulanate, cephalosporins and macrolides were considered broad-spectrum antibiotics.
Results: 295 pre and 278 post-intervention clinic visits were identified for AOM. After CP implementation there was an increase in: watchful waiting without antibiotics (21.7% vs. 33.1%, p<0.01) 2),use of narrow spectrum first line therapy (25.1% vs. 34.5%, p<0.01), with a decrease from 53.2% to 32.4% (p<0.01) in overall prescription of broad-spectrum antibiotics (Fig 1). 156 pre and171 post-implementation clinic visits were identified for GAS pharyngitis, with an increase in narrow spectrum antibiotic prescription (51.9% vs. 90.7%, p<0.01) and decrease in broad-spectrum prescription (48.1% vs. 9.3%, p<0.01)(Fig 2). 68 children with CAP were enrolled pre-intervention and 60 post-intervention. Overall, a significant reduction was seen in boad-spectrum antibiotic prescriptions for inpatient and clinic visits after CP introduction and training (p=0.01).
Conclusion: Reductions of broad-spectrum antibiotic prescriptions for AOM, GAS pharyngitis and CAP as well as increased watchful waiting without antibiotics for AOM indicate promise of CPs for AS in this setting.
Fig. 1 Broad-spectrum antibiotic prescriptions for AOM
Fig. 2 Broad-spectrum antibiotic prescriptions for GAS pharyngitis
G. Brigadoi, None
S. Zingarella, None
R. Lundin, None
R. F. Hamdy, None
T. Zaoutis, None
L. Da Dalt, None
C. Giaquinto, None