Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
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DOI：
10.57264/cer-2023-0088
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发表时间：
2023-11
影响因子：
2.1
通讯作者：
Frost HM
中科院分区：
文献类型：
--
作者：
Keith A;Jenkins TC;O'Leary S;Stein AB;Katz SE;Newland J;Rinehart DJ;Gilbert A;Dodd S;Terrill CM;Frost HM
预防不必要的长时间抗生素治疗是减少2岁及以上急性中耳炎(AOM)儿童过度使用抗生素的关键机会。迫切需要采取务实的干预措施，以缩短可有效扩大和持续的治疗持续时间。这项研究旨在通过评估两种不同强度的低成本干预措施的有效性和实施结果来填补这一空白，以延长AOM儿童符合指南的抗生素持续时间。高强度干预将包括关于指南推荐的短疗程抗生素治疗的临床医生教育；电子健康记录(EHR)处方领域的改变，以促进推荐短疗程的处方；与同行相比，个性化的临床医生审计和关于遵守推荐短疗程治疗的反馈，而低强度干预将仅包括临床医生教育和EHR改变。我们将根据所服务的患者群体、临床医生类型、临床环境和组织以及干预类型来探讨实施效果的差异。将比较不同临床医师类型、患者群体、临床环境和干预类型之间干预措施的保真度、可行性、可接受性和感知适当性。我们还将与临床医生和管理人员以及与患者父母的焦点小组进行形成性定性访谈，以进一步了解干预和研究情况。形成性评估将在15年内进行，干预措施将在2年内实施，干预措施的评估将在15年内进行。这项研究的结果将为其他保健系统提供一个框架，以解决AOM治疗持续时间过长的普遍问题，并为国家抗生素管理政策的制定提供信息。临床试验注册：NCT05608993(ClinicalTrials.gov)耳朵感染是给儿童开抗生素的最常见原因。国家指南建议大多数2岁以上的儿童服用5-7天的抗生素，但超过90%的儿童的处方持续时间超过5-7天，导致不必要的抗生素暴露。本文详细介绍了一项研究的方案，该研究评估了两种旨在减少2岁及以上患有耳部感染的儿童过度使用抗生素的干预措施。这项研究在美国田纳西州纳什维尔的范德比尔特大学医学中心和美国密苏里州华盛顿大学医学中心的35家诊所进行。这项研究的结果将为其他医疗保健系统提供一个框架，以解决抗生素治疗持续时间过长的普遍问题，并有助于制定政策，以指导临床医生如何为儿童耳部感染开出抗生素。这项研究评估了减少耳朵感染儿童过度使用抗生素的干预措施。它将提供一个框架，以解决治疗持续时间过长的问题，并为管理政策提供信息。
Preventing unnecessarily long durations of antibiotic therapy is a key opportunity to reduce antibiotic overuse in children 2 years of age and older with acute otitis media (AOM). Pragmatic interventions to reduce durations of therapy that can be effectively scaled and sustained are urgently needed. This study aims to fill this gap by evaluating the effectiveness and implementation outcomes of two low-cost interventions of differing intensities to increase guideline-concordant antibiotic durations in children with AOM. The higher intensity intervention will consist of clinician education regarding guideline-recommended short durations of antibiotic therapy; electronic health record (EHR) prescription field changes to promote prescribing of recommended short durations; and individualized clinician audit and feedback on adherence to recommended short durations of therapy in comparison to peers, while the lower intensity intervention will consist only of clinician education and EHR changes. We will explore the differences in implementation effectiveness by patient population served, clinician type, clinical setting and organization as well as intervention type. The fidelity, feasibility, acceptability and perceived appropriateness of the interventions among different clinician types, patient populations, clinical settings and intervention type will be compared. We will also conduct formative qualitative interviews with clinicians and administrators and focus groups with parents of patients to further inform the interventions and study. The formative evaluation will take place over 1.5 years, the interventions will be implemented over 2 years and evaluation of the interventions will take place over 1.5 years. The results of this study will provide a framework for other healthcare systems to address the widespread problem of excessive durations of therapy for AOM and inform national antibiotic stewardship policy development. Clinical Trial Registration: NCT05608993 (ClinicalTrials.gov) Ear infections are the most common reason children are prescribed antibiotics. National guidelines recommend 5–7 days of antibiotics for most children over 2 years of age, but over 90% of children are prescribed durations over 5–7 days, resulting in unnecessary exposure to antibiotics. This article details the protocol for a study that evaluates two interventions that aim to reduce antibiotic overuse in children 2 years of age and older with ear infections. This study takes place in 35 clinics at Vanderbilt University Medical Center in Nashville, TN, USA and Washington University Medical Center in MO, USA. The results of this study will provide a framework for other healthcare systems to address the widespread problem of longer than necessary durations of antibiotic treatment and help inform the development of policies to guide how clinicians prescribe antibiotics for childhood ear infections. This study evaluates interventions to reduce antibiotic overuse in children with ear infections. It will provide a framework to address the problem of excessive durations of therapy and inform stewardship policy.
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