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Including preset treatment orders in the electronic medical records of children with ear infections dramatically improved compliance with antibiotic treatment guidelines, researchers reported at IDWeek 2024.
In a study conducted at the University of Colorado/Children’s Hospital Colorado, researchers analyzed data on 34,324 children aged 61 days to 18 months who visited emergency and urgent care centers in the health system for acute otitis media (AOM) from January 2019 to September 2023. Their aim was to assess the effectiveness of a bundled intervention for AOM that included an electronic health record (EHR) order set (implemented in April 2021) that pre-selected a 5-day antibiotic course for children 24 months and older and a local clinical care pathway (implemented in December 2022) that encouraged observation and pain management for children with non-severe AOM.
Presenting author Joana Dimo, DO, a doctoral fellow at the University of Colorado, said the bundle was developed to address a common problem in antibiotic prescribing for AOM: while most cases (up to 75%) resolve without antibiotics, most children receive antibiotics, often for longer than needed.
“We noticed at our institution that children were being prescribed a lot of antibiotics for ear infections, and that the duration of antibiotics was longer than we thought necessary,” Dimo said at a press briefing.
80% improvement in compliance
Although antibiotic prescribing remained high throughout the study (88% to 93%), the researchers found that after the EHR order set was implemented, compliance with the recommended antibiotic duration of 5 days rose from 3% to 83%. Rates of amoxicillin prescribing fell from 77% to 74%, a finding the study authors attribute to an amoxicillin shortage that began in October 2022.
“With this initiative, we were able to show a dramatic 80% improvement in prescribing 5-day durations of antibiotics for children over 2 with a simple and cost-effective strategy that did not lead to increased treatment failures or complications,” Dimo said, adding that shortening the antibiotic duration effectively cut antibiotic use for AOM in half.