Dorzin Sasha E, Halaby Claudia, Quintos Maria Lyn, Noor Asif, El-Chaar Gladys
Department of Pharmacy (SED, GE), NYU Winthrop Hospital, Mineola, New York, Pediatric Pulmonary Medicine (CH), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Quality and Patient Safety (MLQ), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Pediatric Infectious Diseases (AN), the Children's Medical Center, NYU Winthrop Hospital, Mineola, New York, Department of Pharmacy (GE), NYU Winthrop Hospital, Mineola, New York, and Department of Clinical Health Professions, St John's University College of Pharmacy and Health Sciences, Jamaica, New York.
J Pediatr Pharmacol Ther. 2017 Nov-Dec;22(6):436-443. doi: 10.5863/1551-6776-22.6.436.
Antimicrobial stewardship programs (ASPs) ensure appropriate antibiotic use, reduce health care costs, and minimize antibiotic resistance. National asthma guidelines do not recommend antibiotics during an exacerbation unless the child has an infection or comorbidities. The American Academy of Pediatrics (AAP) established a benchmark for unjustified antibiotic use at 6.6%.9 A retrospective study at our institution showed that 7.8% of antibiotics were prescribed without justification in children admitted for asthma. The purpose of this study was to reduce unjustified antibiotic use at our institution by 25% in children through an ASP directed toward asthma.
The study period lasted from November 2015 to March 2016. Children 6 months to 17 years of age, admitted for an asthma exacerbation, were included while those with comorbidities were excluded. A multidisciplinary team from pediatric pharmacotherapy, pulmonology, emergency department (ED), infectious diseases, and quality improvement was formed to focus on process improvement. Interventions were executed in a series of Plan-Do-Study-Act cycles. In cycle 1, our asthma guidelines on appropriate antibiotic use were disseminated to pediatric house staff and posted in pediatric units. Cycle 2 encompassed presenting the ASP and guidelines to the pediatric ED staff. Cycle 3 consisted of a journal club with the pulmonary division to discuss the role of azithromycin in an asthma exacerbation.
In cycle 1, twenty-four patients were reviewed in November 2015. Antibiotics were prescribed in 8/24 (33%) children, with an unjustified rate of 2/24 (8.3%). In cycle 2, twenty-three patients were reviewed in December and January with 8/23 (35%) prescribed antibiotics and an unjustified rate of 2/23 (8.7%). For cycle 3, in February and March 2016, twenty-one children were reviewed. Antibiotics were prescribed in 6/21 (27%) children and all were justified. In total, 68 patients were included in our study and had an unjustified antibiotic prescribing rate of 4/68 (5.9%), a reduction of 25%.
Our ASP surpassed the benchmark set by AAP guidelines, by reducing the percentage of unjustified antibiotics in children with asthma to 5.9%.
抗菌药物管理计划（ASP）可确保抗生素的合理使用，降低医疗成本，并最大限度地减少抗生素耐药性。国家哮喘指南不建议在哮喘发作期间使用抗生素，除非儿童有感染或合并症。美国儿科学会（AAP）设定了不合理使用抗生素的基准为6.6%。我们机构的一项回顾性研究表明，因哮喘入院的儿童中，7.8%的抗生素处方是不合理的。本研究的目的是通过针对哮喘的ASP将我们机构中儿童不合理使用抗生素的情况减少25%。
研究期从2015年11月持续至2016年3月。纳入6个月至17岁因哮喘发作入院的儿童，排除有合并症的儿童。组建了一个由儿科药物治疗、肺病学、急诊科（ED）、传染病和质量改进方面的人员组成的多学科团队，专注于流程改进。干预措施以一系列的计划-执行-研究-行动循环进行。在第1个循环中，我们关于合理使用抗生素的哮喘指南分发给了儿科住院医师，并张贴在儿科病房。第2个循环包括向儿科急诊科工作人员介绍ASP和指南。第3个循环是与肺病科开展一个期刊俱乐部，讨论阿奇霉素在哮喘发作中的作用。
在第1个循环中，2015年11月对24例患者进行了评估。24例儿童中有8例（33%）使用了抗生素，不合理使用率为2/24（8.3%）。在第2个循环中，12月和1月对23例患者进行了评估，23例中有8例（35%）使用了抗生素，不合理使用率为2/23（8.7%）。在第3个循环中，2016年2月和3月对21例儿童进行了评估。21例儿童中有6例（27%）使用了抗生素，且所有使用均合理。我们的研究共纳入68例患者，不合理抗生素处方率为4/68（5.9%），降低了25%。
我们的ASP将哮喘儿童不合理使用抗生素的比例降至5.9%。超过了AAP指南设定的基准。
