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Tracking prescribing habits cuts inappropriate antibiotic use

Educating primary care pediatricians about proper antibiotic use and regularly showing them their prescribing habits reduces inappropriate antibiotic prescriptions, says research scheduled to be presented in October in San Diego.

The findings come as physicians increasingly are being challenged to find antibacterial drugs that are effective on their patients due to growing resistance to the medications and a lack of new antibiotics, health professionals say. In some cases, doctors use drugs that were shelved decades ago due to high levels of toxicity or they combine antibiotics to fight infection.

“Improving antibiotic use is a crucial public health goal and [is] necessary, given increasing antibiotic resistance,” said Daniel Diekema, MD, director of the Division of Infectious Diseases at the University of Iowa Carver College of Medicine. “This study shows that the same approaches we use in hospitals can also improve antibiotic use in clinics.”

Dr. Diekema and other experts were to officially hear the findings at the inaugural IDWeek, a meeting of four leading national and international infectious diseases organizations scheduled for Oct. 17-21 in San Diego. The participating organizations were the Infectious Diseases Society of America, the HIV Medicine Assn., the Pediatric Infectious Diseases Society and the Society for Healthcare Epidemiology of America.

The meeting was intended to bring together a diverse group of infectious diseases experts who could discuss ways to apply to patients recent advances in the infectious diseases field.

More than 170 abstracts were scheduled on advances in the prevention, diagnosis, epidemiology and treatment of infectious diseases for pediatric and adult patients, as well as for individuals with HIV/AIDS. Topics included the importance of disease prevention, combating drug resistance and the role of the environment in preventing hospital-acquired infections among patients.

One unpublished study on disease prevention assessed the effectiveness of school-based immunization programs in protecting students against influenza during the 2010-11 flu season.

Researchers examined data on 4,465 children in kindergarten through sixth grade at eight elementary schools in the Los Angeles area. Four of the schools offered flu shots to children whose parents signed a consent form.

Researchers found that influenza rates were lower in schools with an immunization program (3.9 cases per 100 children) compared with schools that did not provide flu vaccine (5.5 cases per 100 children).

“It seems like the best place to prevent community spread of influenza is actually to go and prevent it at the school level,” said lead researcher Pia Pannaraj, MD, MPH. She is a pediatric infectious diseases specialist at Children’s Hospital Los Angeles.

In another study scheduled to be presented at the meeting, infectious diseases clinical pharmacists reviewed the medication profiles of 155 HIV-infected patients receiving highly active anti-retroviral therapy treatment at the University of Chicago Medical Center during an 18-month period. The review was made within 24 hours of each patient’s admission to the medical center.

Nearly half of the initial hospital-prescribed HAART regimens required intervention. In most cases, the dosage of the medications were modified.

Researchers recommend that hospitals provide additional educational training to health professionals on properly managing HAART regiments. They also suggest that hospitals create innovative ways to catch and prevent errors associated with anti-retroviral treatment.

In a separate study scheduled for the meeting, researchers examined the prescribing habits of 174 pediatricians at 18 practices in Pennsylvania and New Jersey between October 2008 and June 2011. They assessed prescriptions that were issued for sinusitis, group A strep throat and pneumonia. The practices randomly were divided into an intervention group and a control group.

Physicians in the intervention group were educated on the latest antibiotic prescribing guidelines recommended by the American Academy of Pediatrics. They also received quarterly updates that showed how their prescribing habits compared with AAP guidelines and the habits of other pediatricians in their practice.

After one year, inappropriate antibiotic prescribing (also referred to as off-guideline prescribing) for acute respiratory tract infections decreased from 32% to 17% among doctors in the intervention group. In the control group, off-guideline prescribing fell from 33% to 24%.

“If you really want to impact antibiotic use, you have to do it with outpatient prescribing,” said lead researcher Jeffrey Gerber, MD, PhD, assistant professor of pediatrics at the Children’s Hospital of Philadelphia. “Our message is that targeting common conditions and intervening in the outpatient setting is doable.”

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