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PEDIATRICS Vol. 108 No. 3 September 2001, pp. 575-583

A Community Intervention Trial to Promote Judicious Antibiotic Use and Reduce Penicillin-Resistant Streptococcus pneumoniae Carriage in Children

Received Nov 7, 2000; accepted Jan 24, 2001.

Edward A. Belongia*, Bradley J. Sullivan*, Po-Huang Chyou*, Elisabeth MadagameDagger , Kurt D. Reed*, and Benjamin Schwartz§

From the * Marshfield Medical Research Foundation and Marshfield Clinic, Marshfield, Wisconsin; Dagger  Community Health Care, Wausau, Wisconsin, and § National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Objective.  Inappropriate use of antibiotics is common in primary care, and effective interventions are needed to promote judicious antibiotic use and reduce antibiotic resistance. The objective of this study was to assess the impact of parent and clinician education on pediatric antibiotic prescribing and carriage of penicillin-nonsusceptible Streptococcus pneumoniae in child care facilities.

Methods.  A nonrandomized, controlled, community intervention trial was conducted in northern Wisconsin Clinicians. Clinic staff received educational materials and small-group presentations; materials were distributed to parents through clinics, child care facilities, and community organizations. Prescribing data were analyzed for 151 clinicians who provided primary pediatric care; nasopharyngeal carriage of penicillin-nonsusceptible S pneumoniae was assessed for 664 children in the baseline period (January-June 1997) and for 472 children in the postintervention period (January-June 1998).

Results.  The median number of solid antibiotic prescriptions per clinician declined 19% in the intervention region and 8% in the control region. The median number of liquid antibiotic prescriptions per clinician declined 11% in the intervention region, compared with an increase of 12% in the control region. Retail antibiotic sales declined in the intervention region but not in the control region. Among participating children in child care facilities, there were no significant differences in antibiotic use or penicillin-nonsusceptible S pneumoniae colonization between the intervention and control regions.

Conclusions.  A multifaceted educational program for clinicians and parents led to community-wide reductions in antibiotic prescribing, but in child care facilities, there was no apparent impact on judicious antibiotic use or colonization with drug-resistant S pneumoniae. Longer follow-up time or greater reductions in antibiotic use may be required to identify changes in the pneumococcal susceptibility.  Key words:  Streptococcus pneumoniae, antimicrobial resistance, antibiotic prescribing, health education, community interventions.




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