title: A multifaceted approach to decrease inappropriate antibiotic use in a pediatric outpatient clinic.
abstract: BACKGROUND
  Inappropriate use of antimicrobial agents is the major cause for the development of resistance. Thus, it is important to include outpatient clinics in the development of antibiotic stewardship program.
  
  
  METHODS
  We report a multifaceted approach to decrease inappropriate antibiotic use in upper respiratory tract infections (URTIs) in an outpatient pediatric clinic. The interventions included educational grand round, academic detailing, and prospective audit and feedback and peer comparison.
  
  
  RESULTS
  During the study period, a total of 3677 outpatient clinic visits for URTIs were evaluated. Of all the included patients, 12% were <1 year of age, 42% were 1-5 years, and 46% were >5 years of age. Of the total patients, 684 (17.6%) received appropriate antibiotics, 2812 (76.4%) appropriately did not receive antibiotics, and 217 (6%) inappropriately received antibiotics. The monthly rate of prescription of inappropriate antibiotics significantly decreased from 12.3% at the beginning of the study to 3.8% at the end of the study (P< 0.0001). Antibiotic prescription among those who had rapid streptococcal antigen test (RSAT) was 40% compared with 78% among those who did not have RSAT (P< 0.0001).
  
  
  CONCLUSIONS
  The combination of education and academic detailing is important to improve antibiotic use.
authors.affiliation: Department of Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.affiliation: Department of Pediatric, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
authors.forename: Amel H
authors.initials: AH
authors.lastname: Alawami
keywords: Antibiotic; antimicrobial stewardship; rapid streptococcal antigen; upper respiratory tract infection