A Community Intervention Trial to Promote Judicious Antibiotic Use and Reduce Penicillin-Resistant Streptococcus pneumoniae Carriage in Children

• Published in: Pediatrics (Evanston) Vol. 108; no. 3; pp. 575 - 583
• Main Authors: Belongia, Edward A, Sullivan, Bradley J, Chyou, Po-Huang, Madagame, Elisabeth, Reed, Kurt D, Schwartz, Benjamin
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL Am Acad Pediatrics 01-09-2001; American Academy of Pediatrics
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Child Day Care Centers - statistics & numerical data; Child, Preschool; Disease Transmission, Infectious - prevention & control; Drug Prescriptions - statistics & numerical data; Drug resistance in microorganisms; Drug use; Drug Utilization - statistics & numerical data; Health aspects; Health education; Health Education - organization & administration; Humans; Infant; Intervention; Medical sciences; Microbial drug resistance; Nose - microbiology; Outcome Assessment (Health Care); Pediatrics; Penicillin Resistance; Pharmacology. Drug treatments; Pneumococcal Infections - diagnosis; Pneumococcal Infections - drug therapy; Pneumococcal Infections - transmission; Pneumonia; Practice Patterns, Physicians' - statistics & numerical data; Prevention; Primary Health Care - statistics & numerical data; Regression Analysis; Streptococcus pneumoniae; Wisconsin; Wisconsin; Human; Sanitary program; Parent; Health promotion; Physician; Operation; Health education; Streptococcus pneumoniae; Infection; Streptococcaceae; Antibiotic; Medical prescription; Streptococcal infection; Bacteriosis; Bacteria; Micrococcales; Child; Public health
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.108.3.575

Inappropriate use of antibiotics is common in primary care, and effective interventions are needed to promote judicious antibiotic use and reduce antibiotic resistance. The objective of this study was to assess the impact of parent and clinician education on pediatric antibiotic prescribing and carriage of penicillin-nonsusceptible Streptococcus pneumoniae in child care facilities.
A nonrandomized, controlled, community intervention trial was conducted in northern Wisconsin Clinicians. Clinic staff received educational materials and small-group presentations; materials were distributed to parents through clinics, child care facilities, and community organizations. Prescribing data were analyzed for 151 clinicians who provided primary pediatric care; nasopharyngeal carriage of penicillin-nonsusceptible S pneumoniae was assessed for 664 children in the baseline period (January-June 1997) and for 472 children in the postintervention period (January-June 1998).
The median number of solid antibiotic prescriptions per clinician declined 19% in the intervention region and 8% in the control region. The median number of liquid antibiotic prescriptions per clinician declined 11% in the intervention region, compared with an increase of 12% in the control region. Retail antibiotic sales declined in the intervention region but not in the control region. Among participating children in child care facilities, there were no significant differences in antibiotic use or penicillin-nonsusceptible S pneumoniae colonization between the intervention and control regions.
A multifaceted educational program for clinicians and parents led to community-wide reductions in antibiotic prescribing, but in child care facilities, there was no apparent impact on judicious antibiotic use or colonization with drug-resistant S pneumoniae. Longer follow-up time or greater reductions in antibiotic use may be required to identify changes in the pneumococcal susceptibility.