Antimicrobial Stewardship Program for Broad-Spectrum Oral Antibiotic Use in a Pediatric Emergency Department: an Interrupted Time-Series Analysis

BACKGROUND: Oral third-generation cephalosporins are often inappropriately prescribed at outpatient clinics in Japan for mild infections by viruses and bacteria susceptible to agents with a narrower spectrum despite the absence of any recommendations for the use of these drugs as a first-line treatment in the existing guidelines. Our aim was to evaluate an antimicrobial stewardship program (ASP) targeting outpatient use of oral third-cephalosporins at an emergency department. METHODS: Patients visiting the emergency department (ED) at Tokyo Metropolitan Children’s Medical Center in Japan between March 2010 and May 2016 were included. The first period (pre-intervention) between March 2010 and September 2010 had no ASP; the second period (intervention 1) between October 2010 and March 2013 had an ASP with consultations with an infectious diseases’ physician and a no-antibiotic policy for the common cold; and the third period (intervention 2) between April 2013 and May 2016 included an ASP with the requirement for permission to prescribe oral third-generation cephalosporins. We compared the number of prescriptions for third-generation cephalosporin’s prescriptions among the three periods. Antibiotic use was calculated by the number of prescriptions per 1,000 ED visits. RESULTS: In total 232,548 patients were included. Oral antibiotics were prescribed for 13,227 cases (5.7 %). Boys numbered 7,440 (66 %), and the median age was 54 months (IQR: 27-98 months). After interventions 1 and 2, the use of oral third-generation cephalosporins declined from 19 per 1,000 ED visits in the pre-intervention period to 6.6 per 1,000 ED visits during intervention 1 (−4.0; 95% CI −6.3 to −1.7, P = 0.001) and 0.10 per 1,000 ED visits during intervention 2 (−0.31; 95% CI −1.8 to 1.2, P = 0.675). CONCLUSION: The ASP at our ED was effective in decreasing the prescription of oral third-generation cephalosporins. DISCLOSURES: All authors: No reported disclosures.