Evidence-Based Practice: Reducing Unnecessary Antibiotic Prescriptions for Pediatric Pharyngitis

The purpose of this project was to decrease of the rate of unnecessary antibiotic prescribing for pharyngitis by implementing an evidence-based training session for physicians in an outpatient pediatric setting. The PICOT question explored was, "For health providers treating children aged 4–15 presenting with sore throat, will the use of a power point training session presenting the rapid antigen detection test (RADT) with reflexive culture, combined with the ICE (ideas, concern and expectations) method, improve knowledge and reduce antibiotic prescribing compared to RADT alone in a 20 day period?" The provider study group consisted of four pediatricians and one family practice physician ranging from 32–72 years old. Their pre-test (34.63%) and post-test (53.75%) knowledge scores were significantly different ( t = –2.3822, df = 6, p < 0.05). A total of 125 cases were sampled, 64 pre-intervention and 61 post-intervention. Pearson’s Chi Square analysis revealed homogeneity between both the groups in age (X2 = 0.94, df = 1, p = 0.33), gender (X2 = 0.64, df = 1, p = 0.42), and ethnicity (X2 = 1.29, df = 2, p = 0.53) and a decrease in overall antibiotic prescribing rates from 40.6% (n = 26) to 27.9% (n = 17). Although this was not a significant statistical reduction (p = .13), further analysis using a binomial test revealed statistically different rates of success in the accuracy of diagnosis and associated antibiotic prescribing pre-intervention (79.7%) compared to 96.7% post-intervention (p = .00; 95% CI [88.7, 99.6]). Unnecessary antibiotic exposure was reduced by 17.2%. The most common ICE elements were thought of possible strep infection (39), viral or other infection (26), concern for pain (24), infecting other family members (14), fever (14), expectation to get better (32), test for strep (18), and pain relief (9). Only 2 of the 5 cases in the post-intervention group (n = 61) who expressed desire for antibiotics received them