A community intervention trial to promote judicious antibiotic use and reduce penicillin-resistant Streptococcus pneumoniae carriage in children

Objective. Inappropriate use of antibiotics is common in primary care, and effective interventions are needed to promote judicious antibiotic use and reduce antibiotic resistance. The objective of this study was to assess the impact of parent and clinician education on pediatric antibiotic prescribi ng and carriage of penicillin-nonsusceptible Streptococcus pneumoniae in ch ild care facilities. Methods. A nonrandomized, controlled, community intervention trial was cond ucted in northern Wisconsin Clinicians. Clinic staff received educational m aterials and small-group presentations; materials were distributed to paren ts through clinics, child care facilities, and community organizations. Pre scribing data were analyzed for 151 clinicians who provided primary pediatr ic care; nasopharyngeal carriage of penicillin-nonsusceptible S pneumoniae was assessed for 664 children in the baseline period (January-June 1997) an d for 472 children in the postintervention period (January-June 1998). Results. The median number of solid antibiotic prescriptions per clinician declined 19% in the intervention region and 8% in the control region. The m edian number of liquid antibiotic prescriptions per clinician declined 11% in the intervention region, compared with an increase of 12% in the control region. Retail antibiotic sales declined in the intervention region but no t in the control region. Among participating children in child care facilit ies, there were no significant differences in antibiotic use or penicillin- nonsusceptible S pneumoniae colonization between the intervention and contr ol regions. Conclusions. A multifaceted educational program for clinicians and parents led to community-wide reductions in antibiotic prescribing, but in child ca re facilities, there was no apparent impact on judicious antibiotic use or colonization with drug-resistant S pneumoniae. Longer follow-up time or gre ater reductions in antibiotic use may be required to identify changes in th e pneumococcal susceptibility.