Reducing Antibiotic Use in Children: A Randomized Trial in 12 Practices

Finkelstein, Jonathan A.; Davis, Robert L.; Dowell, Scott F.; Metlay, Joshua P.; Soumerai, Stephen B.; Rifas‐Shiman, Sheryl L.; Higham, Margaret; Miller, Zachary; Miroshnik, Irina; Pedan, Alex; Platt, Richard

doi:10.1542/peds.108.1.1

Cited by 340 publications

(207 citation statements)

References 32 publications

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“…In human research, the link between heavy drinking occasions during pregnancy and the risk of FAS is well established 65, 66, 67, 68, 69, 70. For low amounts of alcohol (8–28 g per occasion), several studies have found that there is no increased risk of behavioural and/or developmental deficits in children 69, 71, 72, 73.…”

Section: Resultsmentioning

confidence: 99%

“…For low amounts of alcohol (8–28 g per occasion), several studies have found that there is no increased risk of behavioural and/or developmental deficits in children 69, 71, 72, 73. However, there is some evidence that the consumption of 42–56 g per week during pregnancy may have adverse effects on neurodevelopment 70. To date, however, there are no longitudinal human studies that have followed alcohol‐exposed individuals over a sufficient amount of time and used FASD diagnostic criteria to establish the relationship between dose and/or pattern of alcohol intake during pregnancy and FASD.…”

Section: Resultsmentioning

confidence: 99%

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The relationship between different dimensions of alcohol use and the burden of disease—an update

et al. 2017

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Background and aimsAlcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).MethodsSystematic review of reviews and meta‐analyses on alcohol consumption and health outcomes attributable to alcohol use.For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.ResultsIn total, 255 reviews and meta‐analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD‐10 three‐digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in‐depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.ConclusionsResearch since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The relationship between different dimensions of alcohol use and the burden of disease—an update

et al. 2017

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“…This finding is consistent with others that have demonstrated a relationship between education and more judicious use of antibiotics for pediatric upper respiratory illnesses. [34][35][36] Patient asthma education is increasingly being viewed as an important marker of quality of care in the ambulatory care setting. 37 The results from this finding suggest other potential benefits for asthma education, as it seems to be associated with more judicious use of antibiotics by providers.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing During Pediatric Ambulatory Care Visits for Asthma

et al. 2011

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OBJECTIVE: National guidelines do not recommend antibiotics as an asthma therapy. We sought to examine the frequency of inappropriate antibiotic prescribing during US ambulatory care pediatric asthma visits as well as the patient, provider, and systemic variables associated with such practice. PATIENTS AND METHODS: Data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey were examined to assess office and emergency-department asthma visits made by children (aged <18 years) for frequencies of antibiotic prescription. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to assess the presence of coexisting conditions warranting antibiotics. Multivariable logistic regression models assessed associations with the prescription of antibiotics. RESULTS: From 1998 to 2007, an estimated 60.4 million visits occurred for asthma without another ICD-9 code justifying antibiotic prescription. Antibiotics were prescribed during 16% of these visits, most commonly macrolides (48.8%). In multivariate analysis, controlling for patient age, gender, race, insurance type, region, and controller medication use, systemic corticosteroid prescription (odds ratio [OR]: 2.69 [95% confidence interval (CI): 1.68–4.30]) and treatment during the winter (OR: 1.92 [95% CI: 1.05–3.52]) were associated with an increased likelihood of antibiotic prescription, whereas treatment in an emergency department was associated with decreased likelihood (OR: 0.48 [95% CI: 0.26–0.89]). A second multivariate analysis of only office-based visits demonstrated that asthma education during the visits was associated with reduced antibiotic prescriptions (OR: 0.46 [95% CI: 0.24–0.86]). CONCLUSIONS: Antibiotics are prescribed during nearly 1 in 6 US pediatric ambulatory care visits for asthma, ∼1 million prescriptions annually, when antibiotic need is undocumented. Additional education and interventions are needed to prevent unnecessary antibiotic prescribing for asthma.

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“…Several studies have reported greater magnitudes of effect of interventions on physician practices. 16,17 These studies may have engaged practices that were most receptive to change in this area and may be less generalizable to community-level approaches for this and other public health problems. True community-level interventions to promote judicious antibiotic use have shown mixed results.…”

Section: Discussionmentioning

confidence: 99%

“…13 It is clear to many that interventions to reduce unnecessary prescribing will require community-level intervention that simultaneously targets all sources of perceived demand for unnecessary antibiotic use, as well as changing the supply side: physician prescribing behavior. 14,15 Among the diverse attempts to intervene in this area have been interventions in specific health care delivery systems 16,17 or for particular conditions, such as otitis media in children 18 and bronchitis in adults. 17 The Centers for Disease Control and Prevention (CDC) have implemented national efforts to address antibiotic overuse through education of providers, 7 as well as campaigns to change the knowledge and attitudes of the public about the harms of antibiotic overuse.…”

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confidence: 99%

Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

et al. 2008

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OBJECTIVES. Reducing unnecessary antibiotic use, particularly among children, continues to be a public health priority. Previous intervention studies have been limited by size or design and have shown mixed results. The objective of this study was to determine the impact of a multifaceted, community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents. In addition, we sought to compare the intervention's impact on commercially and Medicaid-insured children. METHODS. We conducted a controlled, community-level, cluster-randomized trial in 16 nonoverlapping Massachusetts communities, studied from 1998 to 2003. During 3 years, we implemented a physician behavior-change strategy that included guideline dissemination, small-group education, frequent updates and educational materials, and prescribing feedback. Parents received educational materials by mail and in primary care practices, pharmacies, and child care settings. Using health-plan data, we measured changes in antibiotics dispensed per person-year of observation among children who were aged 3 to <72 months, resided in study communities, and were insured by a participating commercial health plan or Medicaid. RESULTS. The data include 223135 person-years of observation. Antibiotic-use rates at baseline were 2.8, 1.7, and 1.4 antibiotics per person-year among those aged 3 to <24, 24 to <48, and 48 to <72 months, respectively. We observed a substantial downward trend in antibiotic prescribing, even in the absence of intervention. The intervention had no additional effect among children aged 3 to <24 months but was responsible for a 4.2% decrease among those aged 24 to <48 months and a 6.7% decrease among those aged 48 to <72 months. The intervention effect was greater among Medicaid-insured children and for broad-spectrum agents. CONCLUSIONS. A sustained, multifaceted, community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends. The more robust impact among Medicaid-insured children and for specific medication classes provides an argument for specific targeting of resources for patient and physician behavior change.

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Reducing Antibiotic Use in Children: A Randomized Trial in 12 Practices

Cited by 340 publications

References 32 publications

The relationship between different dimensions of alcohol use and the burden of disease—an update

The relationship between different dimensions of alcohol use and the burden of disease—an update

Antibiotic Prescribing During Pediatric Ambulatory Care Visits for Asthma

Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

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