STRATEGIES TO OPTIMIZE ANTIBIOTIC STEWARDSHIP IN THE OUTPATIENT PEDIATRIC POPULATION: A REVIEW OF THE LITERATURE

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Date
2023-05-15
Authors
Narrandes, Zandhirsingh
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Introduction: About one-third of all antimicrobial prescriptions are clinically unnecessary and potentially harmful in the outpatient pediatric setting, which is an area that commonly features physician assistants prescribe medications. Behavioural factors were found to influence prescription rates. Purpose of Review: The purpose of this literature review is to present a comprehensive overview of the best available evidence regarding the effectiveness of strategies to optimize prescribing behaviours in outpatient pediatric settings. Methods: 23 articles pertained to five individual stewardship strategies and bundled interventions. Search terms were created from four main categories. Databases were searched for articles by title and abstract for highlighting pediatrics/adolescents, outpatient prescription rates, and effectiveness of antibiotic stewardship strategies. 39 articles were found and 19 articles were chosen for review. Older studies (pre-2017) and those with adult samples were included if recent literature on a strategy was scarce and/or datasets were large. Discussion: Bundled and non-bundled approaches were associated with better first-line antibiotic prescribing, reduced broad-spectrum antibiotic prescribing, reduced prescribed antibiotic durations, increased delayed antibiotic prescriptions, and sustained effects in studies with postintervention periods. However, multiple studies did not utilize a pediatric sample and may limit its generalizability. Conclusion: By engaging in more than one behavioural strategy to combat unnecessary antimicrobial prescriptions, physician assistants in outpatient pediatric settings will be better able to adhere to the judicious use of antimicrobial prescriptions. More research should be undertaken that is specific to a pediatric population, within the Canadian context, and involving physician assistants employed in the community.
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