Table 2:
Successful Antibiotic Stewardship Initiatives
| Study | Pediatric Setting | Interventions | Improvements |
|---|---|---|---|
| Norlin et al. [154] | Primary Care Practices (Regional Collaborative) | -Online learning sessions -Independent PDSA cycles by clinics |
-First-line antibiotics: 63.5% to 80.4% -Delayed prescribing: 4.5% to 16.9% - AOM education: 20.4% to 85.6% |
| Nedved et al. [155] | Urgent Care Clinics (National Collaborative) | -MITIGATE Antimicrobial Stewardship Toolkit -Independent PDSA cycles by clinics |
-Appropriate antibiotics (first-line and duration): 43% to 63.4% |
| Wolf et al. [156] | Primary Care Clinics (Single-Center) | -EHR changes with emphasis on notes, discharge instructions, and order alerts -Education |
-Delayed prescribing: 21% to 78% -Adherence to AAP guidelines 78% to 92% |
| Sun et al. [157] | Emergency Departments (Single-Center) | -Education -Sharing data via email -Posters, handouts -Commitment letter |
-Watchful waiting: 2.8% to 11.1% |
| Frost et al. [158] | Primary Care Clinics (Regional Collaborative) | -Education -Subject matter expert support -Online community collaborative -Continuing education credit |
-Delayed prescribing: 2% to 21% |
| Daggett et al. [159] | Emergency Departments (Single-Center) | -Education -Recognizing high-performers -Algorithm -EHR changes |
-Delayed prescribing for all AOM cases: 0.5% to 7.5–7.9% (27.5% qualify) |
| Uhl et al. [99] | Urgent Care Clinics (Single-Center) | -Education Posters -Blog, podcast -Family education -Involve RNs and Pharm -EHR changes – templates |
-Duration: 7% to 67% |
| Frost et al. [111,160] | Primary Care Clinics and School-based Health Centers (regional) | -Audit and Feedback -Education -EHR changes |
-Duration: 10.6% to 85.2% |
| Kaleida et al. [161] | Residency program (National) | -Online curriculum | -Correct diagnosis: 55% to 67% |
| Mousseau et al. [162] | Medical Students (Single-Center) | -e-learning module vs small-group lecture | -Diagnostic Accuracy: 76.4–76.5% |
Abbreviation key: AOM: acute otitis media; EHR: electronic health record; MITIGATE: A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings; PDSA: Plan-Do-Study-Act; RN: registered nurse