Short training programs may help physicians adhere to recommended guidelines for prescription antibiotics with children. The overuse of antibiotics is tied to the evolution of drug-resistant bacteria, so this intervention strategy, reported in JAMA, could help curtail the evolution of dangerous germ strains.

The rapid emergence of microbial drug resistance has been partially blamed on doctors relying too heavily on 'broad-spectrum' antibiotics that target a wide-range of bacteria in cases when more specific 'narrow-spectrum' antibiotics are needed. Another deleterious, but common, practice involves prescribing antibiotics when people are infected with viruses, which will not respond to the treatment.

Both scenarios can apply unnecessary selective pressure on bacteria living inside of us and lead to the evolution of antimicrobial resistance.

This issue is especially relevant in child health care.

"Antibiotics are the most common prescription drugs given to children. Although hospitalized children frequently receive antibiotics, the vast majority of antibiotic use occurs in the outpatient setting, roughly 75 percent of which is for acute respiratory tract infections (ARTIs)," wrote the authors, who were lead by Dr. Jeffrey Gerber, M.D., of The Children's Hospital of Philadelphia.

The American Academy of Pediatrics (AAP) recommends penicillin or amoxicillin — narrow-spectrum antibiotics — for children suffering from strep throat, acute sinus infections, and pneumonia in the lungs.

"However, roughly 50% of children receive broader-spectrum antibiotics for these common infections," the authors wrote.

Intervention training that emphasizes AAP's advice has reduced the overprescription of antibiotics for children staying at hospitals — inpatients — but it is unknown if a similar program would work for outpatient clinics. These short training programs, termed 'antimicrobial stewardship,' are also known to improve inpatient care and reduce overall health care costs for both children and adults.

The researchers signed up 18 outpatient clinics and 162 doctors from New Jersey and Pennsylvania for this study. Starting in October 2008, their prescription habits were tracked, but in June 2010, about half of them — 84 docs — participated in one-hour education sessions that discussed when broad-spectrum antibiotics should be avoided.

This subgroup was then audited on a regular basis and given personalized feedback on their prescribing habits for the next 12 months, while the other 86 doctors continued their regular routine.

The use of broad-spectrum antibiotics was nearly cut in half for the intervention training group (27 percent dropped to 14 percent), whereas a marginal 4-percent reduction was observed with the control group.

A four-fold reduction was observed for the treatment of pneumonia, and sinus infections recorded a 50 percent decrease in broad-spectrum misuse.

Broad-spectrum antibiotics were rarely used for strep throat (about four percent of cases) with and without intervention training. This signals that most doctors are already adhering to the AAP's guidelines for this disease.

"Our findings suggest that extending antimicrobial stewardship to the ambulatory [outpatient] setting, where such programs have generally not been implemented, may have important health benefits," the authors concluded.

Source: Gerber JS, Prasad PA, Fiks AG, et al. Effect of an Outpatient Antimicrobial Stewardship Intervention on Broad-Spectrum Antibiotic Prescribing by Primary Care Pediatricians. JAMA. 2013.