More than 500 out of every 1000 children seen in ambulatory settings and 1 in 3 hospitalized children receive an antibiotic prescription, yet up to half of antibiotics prescribed to children in the US are inappropriate or unnecessary. Excessive antibiotic prescribing exacerbates the global threat of antibiotic-resistant bacteria and subjects children to avoidable and potentially life-long health consequences, adverse medication effects, and healthcare costs. Hospitals and other healthcare organizations increasingly employ antimicrobial stewardship programs and clinical practice guidelines to improve the judicious use of antibiotics. However, many institutions, particularly smaller institutions in community-based settings, face resource constraints that limit the ability of these programs to impact antibiotic prescribing in children. The VIP Network has partnered with hospitals of all sizes to improve resource use and adherence to evidence-based practice for common pediatric conditions.

Building upon these prior experiences, the PACC Quality Network conducted a project that aimed to improve the appropriate use of antibiotics for three common pediatric infections: (1) community-acquired pneumonia (CAP); (2) urinary tract infection (UTI); and (3) skin and soft tissue infections (SSTIs).

We aim to determine the effectiveness and sustainability of extending the VIP’s change package model to multiple pediatric infections at once, and to identify programmatic, institutional, and contextual factors that contribute to maximizing and sustaining desired changes in antibiotic prescribing across a variety of institutional settings.

Project Leadership

Russell J. McCulloh, MD FAAP (Project Leader)
Rana El Feghaly, MD, MSCI, FAAP
Jason Guy Newland, MD, M.Ed
Marie Wang MD, MPH, FAAP
Rachel Cane, MD, PhD
Jessica Markham, MD, MS
Jennifer R. Marin, MD, MSc
Eric Biondi, MD, MS
Matthew Garber, MD, FAAP, FHM
Brittany Jennings – AAP Staff

Project Time Period

Fall 2020 through Winter 2021

Project Aims & Measurement

Project Aim: Assess the impact of implementing evidence-based clinical practice guidelines for antibiotic use in children with CAP, UTI, and SSTI. We hypothesize that participating institutions will increase the proportion of children who receive appropriate empirical antibiotic therapy, definitive therapy, and antibiotic therapy duration for these conditions without increasing the proportion of children experiencing ED revisits or rehospitalizations, transfers to a higher level of medical care, or increased lengths of hospital stay.

Process Measures:

  • Appropriate Empiric Therapy: Increase the proportion started on empiric narrow spectrum therapy based on local susceptibilities. Goal: 85%
  • Appropriate Definitive Therapy: Increase the proportion discharged on the narrowest spectrum definitive therapy given culture results. Goal: 90%
  • Antibiotics Duration: Increase in the proportion of patients with uncomplicated CAP, SSTI, and UTI who receive appropriate antibiotics duration. Goal: 85-90%

Balancing Measures:

  • Revisit/Readmission Rate for same diagnosis 14 days: No change in proportion of children readmitted for any diagnosis. Goal: < 2%
  • Transfer to Higher Level of Care or ICU Admission: No change in rate of transfer to ICU or higher level of care. Goal: No change or increase from baseline.
  • Length of Hospital Stay: Number of hospital days unchanged or decreased post-intervention. Goal: <10% change

Project Resources

Measures Grid