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Changes in Antibiotic Prescribing for Children After a Community-wide Campaign
Joseph F. Perz, DrPH;
Allen S. Craig, MD;
Christopher S. Coffey, PhD;
Daniel M. Jorgensen, MD,MPH;
Edward Mitchel, MS;
Stephanie Hall, MD,MPH;
William Schaffner, MD;
Marie R. Griffin, MD,MPH
JAMA. 2002;287:3103-3109.
Context 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.
Design, Setting, and Participants 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).
Intervention 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).
Main Outcome Measure 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.
Author Affiliations: Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Perz); Communicable and Environmental Disease Services, Tennessee Department of Health, Nashville (Drs Perz, Craig, and Schaffner); Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tenn (Drs Craig, Coffey, Schaffner, and Griffin and Mr Mitchel); Knox County Health Department, Knoxville, Tenn (Drs Jorgensen and Hall). Dr Perz is currently affiliated with the Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga; Dr Coffey is currently affiliated with the Department of Biostatistics, School of Public Health, University of Alabama at Birmingham; and Dr Jorgensen is currently affiliated with Pfizer Global Research and Development, Groton, Conn.
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