Reducing antibiotic use in children: A randomized trial in 12 practices

Objective. To test whether an educational outreach intervention for familie s and physicians, based on the Centers for Disease Control and Prevention ( CDC) principles of judicious antibiotic use, decreases antimicrobial drug p rescribing for children younger than 6 years old. Setting. Twelve practices affiliated with 2 managed care organizations (MCO s) in eastern Massachusetts and northwest Washington State. Patients. All enrolled children younger than 6 years old. Methods. Practices stratified by MCO and size were randomized to interventi on or control groups. The intervention included 2 meetings of the practice with a physician peer leader, using CDC-endorsed summaries of judicious pre scribing recommendations; feedback on previous prescribing rates were also provided. Parents were mailed a CDC brochure on antibiotic use, and support ing materials were displayed in waiting rooms. Automated enrollment, ambula tory visit, and pharmacy claims were used to determine rates of antibiotic courses dispensed (antibiotics/person-year) during baseline (1996-1997) and intervention (1997-1998) years. The primary analysis (for children 3 to <3 6 months and 36 to <72 months) assessed the impact of the intervention amon g children during the intervention year, controlling for covariates includi ng patient age and baseline prescription rate. Confirmatory analyses at the practice level were also performed. Results. The practices cared for 14 468 and 13 460 children in the 2 study years, respectively; 8815 children contributed data in both years. Sixty-tw o percent of antibiotic courses were dispensed for otitis media, 6.5% for p haryngitis, 6.3% for sinusitis, and 9.2% for colds and bronchitis. Antibiot ic dispensing for children 3 to <36 months old decreased 0.41 antibiotics p er person-year (18.6%) in intervention compared with 0.33 (11.5%) in contro l practices. Among children 36 to <72 months old, the rate decreased by 0.2 1 antibiotics per person-year (15%) in intervention and 0.17 (9.8%) in cont rol practices. Multivariate analysis showed an adjusted intervention effect of 16% in the younger and 12% in the older age groups. The direction and a pproximate magnitude of effect were confirmed in practice-level analyses. Conclusions. A limited simultaneous educational outreach intervention for p arents and providers reduced antibiotic use among children in primary care practices, even in the setting of substantial secular trends toward decreas ed prescribing. Future efforts to promote judicious prescribing should cont inue to build on growing public awareness of antibiotic overuse.