Implementing an antibiotic stewardship program to reduce the duration of antibiotics in community-acquired pneumonia: Experience in a French pediatric hospital.

OBJECTIVE

This work used a before-after study to evaluate the impact of a multifaceted stewardship intervention on the recommended duration of antibiotic treatment (5 vs 10 days) for non-severe community-acquired pneumonia (CAP) in pediatrics.

METHODS

Children under age 15 years and 3 months who consulted for CAP in the emergency care unit of Nantes University Hospital from November 2019 to January 2020 and from December 2020 to April 2021 were included. Before the second period, the updated protocol was presented at a local meeting, sent by e-mail, and added to the internal network; physicians' knowledge was tested through clinical situations and answers to the questionnaire as well as pocket cards were distributed. The main outcome was the absolute and relative difference in prescription adequacy according to the recommended duration of antibiotic therapy (5 days) before and after the intervention.

RESULTS

We included 134 children: 71 and 63 before and after the intervention respectively. The proportion of adequate duration of antibiotic therapy prescribed was increased: 27 (38.0 %) children in the "before" group versus 50 (79.4 %) in the "after" group (p < 0.0001). The prescription adequacy ratio (after/before) was 2.09 (95 %CI, 1.51-2.88). The mean treatment duration was significantly higher in the "before" than "after" group: 7.3 versus 5.7 days (p < 0.0001). A total of 155 days of treatment per 100 treated children was avoided. The proportion of correctly prescribed dosages was higher in the "after" than the "before" group: + 18 % (p = 0.03). The proportion of nasopharyngeal PCR tests performed was significantly higher after than before the intervention (p < 0.0001). Chest X-rays were performed in almost all children in both groups.

CONCLUSION

This multifaceted stewardship intervention demonstrated clinically and statistically significant results concerning the prescribed antibiotic therapy duration at individual and population levels and could be extended to other care centers and other situations.