Antimicrobial Stewardship Program for Broad-Spectrum Oral Antibiotic Use in a Pediatric Emergency Department: an Interrupted Time-Series Analysis

Abstract

BackgroundOral third-generation cephalosporins are often inappropriately prescribed at outpatient clinics in Japan for mild infections by viruses and bacteria susceptible to agents with a narrower spectrum despite the absence of any recommendations for the use of these drugs as a first-line treatment in the existing guidelines. Our aim was to evaluate an antimicrobial stewardship program (ASP) targeting outpatient use of oral third-cephalosporins at an emergency department.MethodsPatients visiting the emergency department (ED) at Tokyo Metropolitan Children’s Medical Center in Japan between March 2010 and May 2016 were included. The first period (pre-intervention) between March 2010 and September 2010 had no ASP; the second period (intervention 1) between October 2010 and March 2013 had an ASP with consultations with an infectious diseases’ physician and a no-antibiotic policy for the common cold; and the third period (intervention 2) between April 2013 and May 2016 included an ASP with the requirement for permission to prescribe oral third-generation cephalosporins. We compared the number of prescriptions for third-generation cephalosporin’s prescriptions among the three periods. Antibiotic use was calculated by the number of prescriptions per 1,000 ED visits.ResultsIn total 232,548 patients were included. Oral antibiotics were prescribed for 13,227 cases (5.7 %). Boys numbered 7,440 (66 %), and the median age was 54 months (IQR: 27-98 months). After interventions 1 and 2, the use of oral third-generation cephalosporins declined from 19 per 1,000 ED visits in the pre-intervention period to 6.6 per 1,000 ED visits during intervention 1 (−4.0; 95% CI −6.3 to −1.7, P = 0.001) and 0.10 per 1,000 ED visits during intervention 2 (−0.31; 95% CI −1.8 to 1.2, P = 0.675).ConclusionThe ASP at our ED was effective in decreasing the prescription of oral third-generation cephalosporins.Disclosures All authors: No reported disclosures.