RESUMEN
OBJECTIVE: To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among non-hospitalized children with community-acquired pneumonia. STUDY DESIGN: In a large health care organization, a phase one intervention was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record (EHR). In October 2021, a second phase comprised additional education and order set revisions. A narrow spectrum antibiotic (eg, amoxicillin) was recommended in most circumstances. EHR data were used to identify pneumonia cases and antibiotics ordered. Using interrupted time series analyses, antibiotic choice and duration after phase one (September 2020 to September 2021) and after phase two (October 2021 to October 2022) were compared with a pre-intervention pre-pandemic period (January 2016 to early March 2020). RESULTS: Overall, 3570 cases of community-acquired pneumonia were identified: 3246 cases pre-intervention, 98 post-phase-one, and 226 post-phase-two. The proportion receiving narrow spectrum monotherapy increased from 40.6% pre-intervention to 68.4% post-phase-one to 69.0% post-phase-two (p<0.001). For children with an initial narrow spectrum antibiotic, duration decreased from pre-intervention (mean duration 9.9 days, standard deviation [SD] 0.5 days) to post-phase-one (mean 8.2, SD 1.9) to post-phase-two (mean 6.8, SD 2.3) periods (p<0.001). CONCLUSIONS: A two-phase intervention with educational sessions combined with clinical decision support was associated with sustained improvements in antibiotic choice and duration among children with community-acquired pneumonia.
