Five days of antibiotic treatment for uncomplicated community-acquired pneumonia (CAP) and 5-7 days for uncomplicated skin and soft tissue infection (SSTI) are just as effective as longer courses and reduce the risk of antibiotic-associated adverse effects. Such evidence has prompted the American Academy of Pediatrics Committee on Infectious Diseases to revise its treatment guidelines to recommend shorter course therapy. Are clinicians following these recommendations or continuing to treat their patients with ten-day or longer courses of antibiotics?
With the hope of improving the use of short course treatment for CAP and SST, Vernacchio et al. (10.1542/peds.2023-063691) performed a site-randomized quality-improvement trial, randomly assigning practices in a large pediatric primary care network in Massachusetts into one of four groups: (1) education and performance feedback via monthly emails; (2) clinical decision support with an alert in the electronic health record recommending a shorter course of antibiotics; (3) a combination of 1 and 2; and (4) no intervention. Baseline data was gathered across all practices in 2022, and the intervention then ran for three months. Groups 1, 2, and 3 all had significant improvement. The combined group (3) had the most improvement (26.2% to 67.8% improvement in short course prescriptions written, P<.001) compared to the control group where there was no change (26.1% to 25.8%, P=0.9).
The authors provide interesting thoughts as to why the combination of education and clinical decision support resulted in the greatest improvement. The authors of this study also note how further improvements in both the education of pediatric clinicians and in clinical decision-making alerts used in the EHR could lead to even better outcomes. These interventions are feasible and well worth learning more about it. Link to this study and do just that.
