The Key to Antibiotic Stewardship Is Combining Interventions.

Abstract

* Abbreviation: DART — : Dialogue Around Respiratory Tract Illness Treatment More than 10 million antibiotics are unnecessarily prescribed to children in the United States every year, contributing to increasing antibiotic resistance and adverse drug events. The reasons for inappropriate antibiotic prescribing in ambulatory pediatrics are multifactorial, including patient pressures and demand, actual or perceived parental satisfaction, provider knowledge, and provider time constraints.1,2 An effective approach to decreasing inappropriate antibiotic prescribing must therefore address each of these contributing factors. Reflective models of adult learning theory are based on the premise that we learn best when we are told (1) what we are supposed to do, (2) how we should do it, and (3) receive feedback to reflect on how we did.3,4 In this issue of Pediatrics , Kronman et al,5 in their clinical trial based on the theory of planned behavior, also seem to recognize that clinicians are adult learners, and they combine interventions to implement these adult learning theory tenets to improve appropriate antibiotic prescribing. In their cluster-randomized stepped-wedge clinical trial among pediatric providers across the United States, they use (1) … Address correspondence to Rana F. Hamdy, MD, MPH, MSCE, Division of Infectious Diseases, Children’s National Hospital, 111 Michigan Ave NW, West Wing 3.5, Suite 100, Washington, DC 20010. E-mail: rhamdy2{at}childrensnational.org