We assessed the effectiveness of an antibiotic stewardship program (ASP) on antibiotic prescriptions for acute respiratory tract infection (ARTI) in a medical school. Our ASP included delivering an antibiotic use guideline via e-mail and LINE (an instant messaging app) to faculty staff, fellows, and residents, and posting of the guideline in examination rooms. Medical records of pediatric patients diagnosed with ARTI were reviewed to assess the appropriateness of antibiotic prescription. ASP could increase the rate of appropriateness from 78% (1979 out of 2553 visits) to 83.4% (2449 out of 2935 visits; P < .001). The baseline of appropriateness was higher in residents (95%) compared with fellows (82%) and faculty staff (75%). The ASP significantly increased the appropriateness only in faculty staff, especially in semiprivate clinics (75% to 83%, P < .001). In conclusion, our ASP increased appropriateness of antibiotic prescriptions for ARTI, with the greatest impact among faculty staff in semiprivate clinics.

BackgroundUrinary tract infection (UTI) is a common cause of fever in children. Since infections caused by extended-spectrum β-lactamase (ESBL)-producing organism in the community have increased, alternative empirical antimicrobials to carbapenems have been studied. We conducted this study to compare clinical outcomes between group receiving empirical antimicrobials to which organisms were susceptible vs. non-susceptible in community-onset UTI.MethodsWe conducted a retrospective cohort study of pediatric patients with first-episode community-onset febrile UTI caused by Escherichia coli, Klebsiella pneumoniae and Proteus spp. at Ramathibodi Hospital from 2011 to 2017. Patients were classified into group receiving empirical antimicrobials to which organisms were susceptible and non-susceptible. Medical records were reviewed to assess clinical outcomes in both groups.ResultsOne hundred and fifty-one eligible patients were enrolled in this study. The most common causative organism was E. coli (89.6 and 96.2% in the group receiving susceptible and non-susceptible antimicrobials, respectively). Among causative organisms, 19.8% were ESBL-producing organisms. Ceftriaxone was used in 76.8% of our patients. There was no significant difference in clinical, microbiological, relapse, time to defervescence between two groups of patients. None of patients in both groups developed sepsis after receiving empirical therapy. However, length of stay was significantly longer in group receiving antimicrobials to which organisms were non-susceptible (5.12 ± 3.187 vs. 8.54 ± 5.186, P = 0.008).ConclusionThis study found no significant difference in the treatment outcomes between pediatric patients receiving antimicrobials to which organisms were susceptible and non-susceptible for the treatment of UTI.In the era of increasing antimicrobial resistance, third-generation cephalosporins are still a good choice as an empirical antimicrobial for children with community-onset UTI.Disclosures All authors: No reported disclosures.