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Volume 9
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10.3390/antibiotics9120867
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Article

Impact and Sustainability of Antibiotic Stewardship in Pediatric Emergency Departments: Why Persistence Is the Key to Success

by
Elisa Barbieri
1,*,
Maia De Luca
2,
Marta Minute
3,
Carmen D’Amore
4,
Marta Luisa Ciofi Degli Atti
4,
Stefano Martelossi
3,
Carlo Giaquinto
1,
Liviana Da Dalt
5,
Theoklis Zaoutis
6 and
Daniele Dona
1
1
Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35131 Padova, Italy
2
Unit of Immune and Infectious Diseases, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
3
Pediatric Unit, Ca’ Foncello’s Hospital, 31100 Treviso, Italy
4
Unit of Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
5
Pediatric Emergency Department, Department of Women’s and Children’s Health, University Hospital of Padua, 2-35128 Padova, Italy
6
Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
*
Author to whom correspondence should be addressed.
Antibiotics 2020, 9(12), 867; https://doi.org/10.3390/antibiotics9120867
Submission received: 15 October 2020 / Revised: 23 November 2020 / Accepted: 30 November 2020 / Published: 4 December 2020
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 1st Volume)
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Abstract

Antibiotic stewardship programs proved to be effective in improving prescribing appropriateness. This multicenter quasi-experimental study, aimed to assesses the stewardship impact on antibiotics prescribing in different semesters from 2014 to 2019 in three pediatric emergency departments (Center A, B, and C) in Italy. All consecutive patients diagnosed with acute otitis media or pharyngitis were evaluated for inclusion. Two different stewardship were adopted: for Center A and B, clinical pathways were implemented and disseminated, and yearly lectures were held, for Center C, only pathways were implemented. Broad-spectrum prescription rates decreased significantly by 80% for pharyngitis and 29.5 to 55.2% for otitis after the implementation. In Center C, rates gradually increased from the year after the implementation. Amoxicillin dosage adjusted to pharyngitis recommendations in Center C (53.7 vs. 51.6 mg/kg/die; p = 0.011) and otitis recommendations in Center A increasing from 50.0 to 75.0 mg/kg/die (p < 0.001). Days of therapy in children < 24 months with otitis increased from 8.0 to 10.0 in Center A, while in older children decreased in Center A (8.0 vs. 7.0; p < 0.001) and Center B (10.0 vs. 8.0; p < 0.001). Clinical pathways combined with educational lectures is a feasible and sustainable program in reducing broad-spectrum antibiotic prescribing with stable rates over time.
Keywords: antibiotic stewardship; pharyngitis; acute otitis media; clinical pathways; children; emergency departments; antibiotic use; prescribing appropriateness antibiotic stewardship; pharyngitis; acute otitis media; clinical pathways; children; emergency departments; antibiotic use; prescribing appropriateness

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MDPI and ACS Style

Barbieri, E.; De Luca, M.; Minute, M.; D’Amore, C.; Ciofi Degli Atti, M.L.; Martelossi, S.; Giaquinto, C.; Da Dalt, L.; Zaoutis, T.; Dona, D. Impact and Sustainability of Antibiotic Stewardship in Pediatric Emergency Departments: Why Persistence Is the Key to Success. Antibiotics 2020, 9, 867. https://doi.org/10.3390/antibiotics9120867

AMA Style

Barbieri E, De Luca M, Minute M, D’Amore C, Ciofi Degli Atti ML, Martelossi S, Giaquinto C, Da Dalt L, Zaoutis T, Dona D. Impact and Sustainability of Antibiotic Stewardship in Pediatric Emergency Departments: Why Persistence Is the Key to Success. Antibiotics. 2020; 9(12):867. https://doi.org/10.3390/antibiotics9120867

Chicago/Turabian Style

Barbieri, Elisa, Maia De Luca, Marta Minute, Carmen D’Amore, Marta Luisa Ciofi Degli Atti, Stefano Martelossi, Carlo Giaquinto, Liviana Da Dalt, Theoklis Zaoutis, and Daniele Dona. 2020. "Impact and Sustainability of Antibiotic Stewardship in Pediatric Emergency Departments: Why Persistence Is the Key to Success" Antibiotics 9, no. 12: 867. https://doi.org/10.3390/antibiotics9120867

APA Style

Barbieri, E., De Luca, M., Minute, M., D’Amore, C., Ciofi Degli Atti, M. L., Martelossi, S., Giaquinto, C., Da Dalt, L., Zaoutis, T., & Dona, D. (2020). Impact and Sustainability of Antibiotic Stewardship in Pediatric Emergency Departments: Why Persistence Is the Key to Success. Antibiotics, 9(12), 867. https://doi.org/10.3390/antibiotics9120867

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