title: Evaluating Guideline-Recommended Antibiotic Practices for Childhood Respiratory Infections: Is It Time to Consider Case-Based Formats?
abstract: OBJECTIVE
  We sought to better understand barriers to adherence to published guidelines for respiratory infections among community providers.
  
  
  METHODS
  A case-based survey was developed and emailed to all members of the state pediatric society. Providers chose their preferred management for acute otitis media, acute bacterial sinusitis, and community-acquired pneumonia. An "answer key" and a follow-up questionnaire were distributed to assess reevaluation of current practices.
  
  
  RESULTS
  We received 173 completed surveys (15% response rate). While most responders followed guideline recommendations (6 of the 10 questions with ≥ 65% choosing recommended antibiotic), discrepancies existed in several cases. After receiving the answer key, respondents said they reviewed the guidelines (69%), adjusted their practice (26%), used cases for teaching (9%), and discussed guidelines with colleagues (21%).
  
  
  CONCLUSIONS
  The majority of respondents followed published guidelines, but there was a tendency to overuse azithromycin in certain cases. Future guidelines including case-based discussions may enhance adherence.
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Wright
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
authors.forename: Asheley Cockrell
authors.initials: AC
authors.lastname: Skinner
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA ravi.jhaveri@unc.edu.
authors.forename: Ravi
authors.initials: R
authors.lastname: Jhaveri
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: adherence; antibiotics; guidelines