Reducing Antibiotic Use by Implementation of Stewardship in Primary and Urgent Care (RAISIN)

Children's Hospital of Philadelphia (CHOP)

Status: Active, not recruiting

Conditions: Acute Otitis Media (AOM); Strep Pharyngitis; Community Acquired Pneumonia (CAP); Sinusitis

Treatments: Other: Live, hybrid in-person and online educational sessions; Other: Clinical Decision Support; Other: Prescribing Feedback Reports; Other: Online Educational Modules

Study type: Observational

Funder types: Other

Identifiers

NCT07217002

24-021996

Details and patient eligibility

About

The goal of this project is to reduce unnecessary antibiotic use for children with ARTIs (Acute Respiratory Tract Infections) by implementing "outpatient antibiotic stewardship" across the Children's Hospital of Philadelphia (CHOP) Primary and Urgent Care Network to:

1. Reduce unnecessary antibiotic prescribing for the most common infections in children.
2. Reduce unnecessary a) broad-spectrum and b) longer-course antibiotic therapy for ear infections, Strep throat, sinus infections, and pneumonia.

Full description

Children often receive antibiotics for acute respiratory tract infections (ARTIs) which are caused by viruses, such as the common cold. However, antibiotics cannot treat viruses. Using antibiotics when they are not needed can cause harm - including side effects like rashes, vomiting and diarrhea - and can make it harder for the antibiotics to work when they are needed to treat infections caused by bacteria. For ARTIs caused by bacteria - like ear infections, sinus infections, strep throat or pneumonia - narrow-spectrum antibiotics are the best choice. This is because narrow-spectrum antibiotics target only the harmful bacteria, while "broad-spectrum" antibiotics target additional bacteria than can be helpful for the body. For many of these infections, it is also better to use shorter courses of antibiotics (such as five days) instead of longer courses (such as 10 days). Research studies have shown clearly that shorter courses and narrow-spectrum antibiotics cure infections just as well as longer courses and broad-spectrum antibiotics, but with fewer side effects.

Over two years, the project team will use proven strategies to ensure that children get the right antibiotics for the right amount of time. During this time, all pediatric doctors and nurse practitioners in this large, diverse network will receive:

1. Online education about proper antibiotic prescribing.
2. Regular feedback on how their antibiotic prescribing compares to peers and to professional guidelines.
3. Tools in the electronic health record to make it easy to prescribe the right antibiotics.
4. Yearly, live hybrid in-person and online educational sessions

The project team will determine how well this program works by measuring:

1. How often antibiotics are prescribed to children with ARTIs.
2. How often children with bacterial ARTIs (ear infections, sinus infections, strep throat and pneumonia) get the right antibiotic choice and right number of antibiotic days.

Enrollment: 420 estimated patients

Sex: All

Ages: 6 months to 12 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion

• All children ages 6 months to 12 years seen at CHOP primary care network and CHOP Urgent Care with ARTI diagnoses (viral diagnoses or AOM, CAP, sinusitis, strep pharyngitis) Exclusion
• Severe immunocompromised status OR tracheostomy dependence
• Children with other bacterial infection diagnoses

Trial design

420 participants in 1 patient group

CHOP Primary Care Providers

Description:

Providers at all 31 primary care practice offices and 4 urgent care offices that include physicians and Advanced Practice Provider (APPs) including Nurse Practitioners (NPs) and Physicians Assistants (PAs).

Treatment:

Other: Online Educational Modules

Other: Prescribing Feedback Reports

Other: Clinical Decision Support

Other: Live, hybrid in-person and online educational sessions