Changes in antibiotic prescribing for children after a community-wide campaign.
BACKGROUND
Overuse of antibiotics has contributed to microbial resistance, compromising the treatment of bacterial infections. Very high levels (>50%) of antibiotic resistance among invasive Streptococcus pneumoniae have been documented in Knox County, Tennessee.


OBJECTIVE
To determine the effectiveness of a community-wide intervention aimed at reducing inappropriate antibiotic use among children.


METHODS
The Knox County Health Department led a multifaceted year-long campaign (May 1997 through April 1998) aimed at decreasing unnecessary antibiotic use among children. Tennessee's 3 other major urban counties (Shelby, Hamilton, and Davidson) did not conduct similar campaigns and served as controls. Evaluation included white and black children (aged <15 years) enrolled in Tennessee's Medicaid Managed Care Program in the 4 study counties, representing 36% of the study counties' children (464 200 person-years observed).


METHODS
Educational efforts were directed toward health care practitioners (primarily via peer leader presentations) and to the parents of young children and the public (primarily via printed materials).


METHODS
The intervention-attributable effect on antibiotic use, defined as the excess percentage change in oral antibiotic prescription rates in Knox County between the 12-month preintervention and postintervention periods, relative to that of control counties.


RESULTS
Antibiotic prescription rates declined 19% and 8% among Knox County and control county children, respectively, yielding an 11% intervention-attributable decline (95% confidence interval, 8%-14%; P<.001). The intervention-attributable decrease in prescription rates was greatest among children aged 1 to less than 5 years (among white children, 8% [P<.001]; among black children, 18% [P<.001]).


CONCLUSIONS
A community-wide educational intervention reduced antibiotic prescription levels among children in Knox County.
Perz
Joseph F
JF
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Craig
Allen S
AS
Coffey
Christopher S
CS
Jorgensen
Daniel M
DM
Mitchel
Edward
E
Hall
Stephanie
S
Schaffner
William
W
Griffin
Marie R
MR
D000293:Adolescent; D001741:Black or African American; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004351:Drug Resistance; D004363:Drug Utilization / Q000639:trends; D006266:Health Education; D006293:Health Promotion; D006801:Humans; D007223:Infant; D008329:Managed Care Programs; D008484:Medicaid; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013221:State Health Plans; D013714:Tennessee; D014481:United States; D044465:White People
D000900:Anti-Bacterial Agents