Stewardship Intervention Can Cut Inappropriate Rx by a Third

Antibiotic stewardship interventions for acute respiratory infection (ARI) can significantly reduce overuse in emergency departments and urgent care centers, according to a study published online in Academic Emergency Medicine.

Kabir Yadav, M.D.C.M., from Harbor-UCLA Medical Center in Torrence, California, and colleagues compared the effectiveness of an antibiotic stewardship intervention adapted for acute care ambulatory settings to that of an enhanced stewardship intervention that additionally incorporates behavioral nudges in reducing inappropriate prescriptions. The interventions were part of a cluster-randomized trial that occurred in three academic health systems that included five adult and pediatric emergency departments and four urgent care centers, with all providers at each site receiving either the adapted or the enhanced intervention.

The researchers found that there were 44,820 ARI visits among 292 providers across all nine cluster sites. From the 2016-2017 influenza season (baseline) to the 2017-2018 season (intervention), there was a drop in antibiotic prescribing for ARI from 6.2 percent to 2.4 percent. After adjustment for health system and provider-level effects, there was a significant reduction in inappropriate prescribing (2.2 percent to 1.5 percent; odds ratio, 0.67). Difference-in-differences between the two interventions was not significantly different.

"We found education with an on-site champion reduced inappropriate antibiotic use by a third across the board," study author Larissa May, M.D., M.S.P.H., said in a statement. "Our study shows that this relatively simple approach can get us to near-zero inappropriate antibiotic use for acute respiratory infections."

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