title: Decreasing Duration of Antibiotic Prescribing for Uncomplicated Skin and Soft Tissue Infections.
abstract: OBJECTIVE
  Short courses of antibiotics are often indicated for uncomplicated skin and soft tissue infections (uSSTIs). Our objective was to decrease duration of antibiotics prescribed in children hospitalized for uSSTIs by using quality improvement (QI) methods.
  
  
  METHODS
  QI methods were used to decrease duration of antibiotics prescribed upon hospital discharge for uSSTIs. We sought to accomplish this goal by increasing outpatient prescriptions for short courses of therapy (≤7 days). Key drivers included awareness of evidence among physicians, changing the culture of prescribing, buy-in from prescribers, and monitoring of prescribing. Physician education, modification of antibiotic order sets for discharge prescriptions, and continual identification and mitigation of therapy plans, were key interventions implemented by using plan-do-study-act cycles. A run chart assessed the impact of the interventions over time.
  
  
  RESULTS
  We identified 641 index admissions for uSSTIs over a 23-month period for patients aged >90 days to 18 years. The proportion of children discharged with short courses of antibiotics increased from a baseline median of 23% to 74%, which was sustained for 6 months. Differences in the proportion of children admitted for treatment failure or recurrence before and after project initiation were not significant.
  
  
  CONCLUSIONS
  Using QI methodology, we decreased duration of antibiotics prescribed in children hospitalized for uSSTIs by increasing prescriptions for short courses of antibiotics. Modification of electronic order sets for discharge prescriptions allowed for sustained improvement in prescribing practices. Our findings support the use of shorter outpatient antibiotic courses in most children with uSSTIs, and suggest criteria for complicated SSTIs.
authors.affiliation: Division of Hospital Medicine, christine.schuler@cchmc.org.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Schuler
authors.affiliation: Pharmacy.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Courter
authors.affiliation: Pediatric Residency Program.
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Conneely
authors.affiliation: Pediatric Residency Program.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Frost
authors.affiliation: Pediatric Residency Program.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sherenian
authors.affiliation: Division of Hospital Medicine, Divison of Infectious Diseases, Cincinnati Children's Hospital Medical Center.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Division of Hospital Medicine.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Gosdin
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007223:Infant; D008297:Male; D009820:Ohio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D015397:Program Evaluation; D058996:Quality Improvement / Q000706:statistics & numerical data / Q000639:trends*; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents