{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:08:44Z","timestamp":1788307724880,"version":"build-2803163510"},"reference-count":41,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVES:<\/jats:title><jats:p>To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>The study was conducted at Kaiser Permanente Colorado, a large health care organization with \u223c127\u2009000 members &amp;lt;18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants &amp;lt;60 days old and children with complex urologic or neurologic conditions were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (P &amp;lt; .0001). The use of cephalexin (first-line, narrow spectrum) increased from 28.9% preintervention to 53.0% postintervention (P &amp;lt; .0001). The use of cefixime (second-line, broad spectrum) decreased from 17.3% preintervention to 2.6% postintervention (P &amp;lt; .0001). Changes in prescribing practices persisted through the end of the study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2019-2503","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T13:25:22Z","timestamp":1583241922000},"source":"Crossref","is-referenced-by-count":12,"title":["Improving Antibiotic Prescribing for Pediatric Urinary Tract Infections in Outpatient Settings"],"prefix":"10.1542","volume":"145","author":[{"given":"Matthew F.","family":"Daley","sequence":"first","affiliation":[{"name":"Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado;"},{"name":"Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharisse M.","family":"Arnold Rehring","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"},{"name":"Department of Medical Education, Colorado Permanente Medical Group, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen A.","family":"Glenn","sequence":"additional","affiliation":[{"name":"Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liza M.","family":"Reifler","sequence":"additional","affiliation":[{"name":"Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Steiner","sequence":"additional","affiliation":[{"name":"Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado;"},{"name":"Department of Medical Education, Colorado Permanente Medical Group, Denver, Colorado"},{"name":"Medicine, School of Medicine, University of Colorado, Aurora, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2020,4,1]]},"reference":[{"issue":"1","key":"2021121021250832400_B1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.idc.2013.09.003","article-title":"Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden","volume":"28","author":"Foxman","year":"2014","journal-title":"Infect Dis Clin North Am"},{"issue":"4","key":"2021121021250832400_B2","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/INF.0b013e31815e4122","article-title":"Prevalence of urinary tract infection in childhood: a meta-analysis","volume":"27","author":"Shaikh","year":"2008","journal-title":"Pediatr Infect Dis J"},{"issue":"6","key":"2021121021250832400_B3","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1542\/peds.2010-3465","article-title":"National ambulatory antibiotic prescribing patterns for pediatric urinary tract infection, 1998-2007","volume":"127","author":"Copp","year":"2011","journal-title":"Pediatrics"},{"issue":"11","key":"2021121021250832400_B4","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1001\/jama.2016.11764","article-title":"Antimicrobial resistance","volume":"316","author":"Marston","year":"2016","journal-title":"JAMA"},{"issue":"12","key":"2021121021250832400_B5","doi-asserted-by":"crossref","first-page":"e368","DOI":"10.1016\/S1473-3099(18)30296-2","article-title":"Quantifying drivers of antibiotic resistance in humans: a systematic review","volume":"18","author":"Chatterjee","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"5","key":"2021121021250832400_B6","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1093\/jpids\/piy066","article-title":"US emergency department visits for adverse drug events from antibiotics in children, 2011-2015","volume":"8","author":"Lovegrove","year":"2019","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"4","key":"2021121021250832400_B7","doi-asserted-by":"crossref","first-page":"234.e1","DOI":"10.1016\/j.jpurol.2016.05.016","article-title":"Acute health care utilization and outcomes for outpatient-treated urinary tract infections in children","volume":"12","author":"Copp","year":"2016","journal-title":"J Pediatr Urol"},{"issue":"6","key":"2021121021250832400_B8","doi-asserted-by":"crossref","first-page":"e20180290","DOI":"10.1542\/peds.2018-0290","article-title":"Early antibiotic exposure and weight outcomes in young children [published correction appears in Pediatrics. 2019;143(2):e20183555]","volume":"142","author":"Block","year":"2018","journal-title":"Pediatrics"},{"key":"2021121021250832400_B9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12916-016-0605-7","article-title":"Antibiotics, obesity and the link to microbes - what are we doing to our children?","volume":"14","author":"Turta","year":"2016","journal-title":"BMC Med"},{"issue":"6","key":"2021121021250832400_B10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr6506a1","article-title":"Core elements of outpatient antibiotic stewardship","volume":"65","author":"Sanchez","year":"2016","journal-title":"MMWR Recomm Rep"},{"issue":"2","key":"2021121021250832400_B11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1017\/ice.2014.41","article-title":"Antimicrobial stewardship in outpatient settings: a systematic review","volume":"36","author":"Drekonja","year":"2015","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2021121021250832400_B12","unstructured":"Centers for Disease Control and Prevention. Antibiotic prescribing and use in doctor\u2019s offices: measuring outpatient antibiotic prescribing. 2019. Available at: https:\/\/www.cdc.gov\/antibiotic-use\/community\/programs-measurement\/measuring-antibiotic-prescribing.html. Accessed May 21, 2019"},{"key":"2021121021250832400_B13","unstructured":"Centers for Disease Control and Prevention. Antibiotic prescribing and use in doctor's offices: pediatric treatment recommendations. 2019. Available at: https:\/\/www.cdc.gov\/antibiotic-use\/community\/for-hcp\/outpatient-hcp\/pediatric-treatment-rec.html. Accessed June 18, 2019"},{"issue":"10","key":"2021121021250832400_B14","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1093\/cid\/ciw118","article-title":"Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"1","key":"2021121021250832400_B15","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1586\/14787210.2015.986097","article-title":"The diagnosis, evaluation and treatment of acute and recurrent pediatric urinary tract infections","volume":"13","author":"Becknell","year":"2015","journal-title":"Expert Rev Anti Infect Ther"},{"issue":"3","key":"2021121021250832400_B16","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1542\/peds.2011-1330","article-title":"Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months","volume":"128","author":"Roberts","year":"2011","journal-title":"Pediatrics"},{"key":"2021121021250832400_B17","article-title":"Improving antibiotic prescribing for children with urinary tract infection in emergency and urgent care settings [published online ahead of print January 2, 2018]","author":"Poole","journal-title":"Pediatr Emerg Care"},{"issue":"8","key":"2021121021250832400_B18","first-page":"CD006857","article-title":"Antibiotics for treating lower urinary tract infection in children","author":"Fitzgerald","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"2021121021250832400_B19","first-page":"CD003966","article-title":"Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children","author":"Michael","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"2021121021250832400_B20","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1093\/jac\/dkr279","article-title":"Antibiotic prescribing for acute respiratory tract infections in primary care: a systematic review and meta-ethnography","volume":"66","author":"Tonkin-Crine","year":"2011","journal-title":"J Antimicrob Chemother"},{"issue":"9","key":"2021121021250832400_B21","first-page":"CD012252","article-title":"Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews","author":"Tonkin-Crine","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2021121021250832400_B22","doi-asserted-by":"crossref","DOI":"10.17226\/27122","volume-title":"Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series","author":"Tcheng","year":"2017"},{"issue":"2","key":"2021121021250832400_B23","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1136\/amiajnl-2011-000701","article-title":"Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial","volume":"20","author":"Mainous","year":"2013","journal-title":"J Am Med Inform Assoc"},{"key":"2021121021250832400_B24","volume-title":"Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary","author":"Institute of Medicine","year":"2011"},{"issue":"1","key":"2021121021250832400_B25","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"46","author":"Bernal","year":"2017","journal-title":"Int J Epidemiol"},{"issue":"2","key":"2021121021250832400_B26","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/jep.12638","article-title":"Challenges to validity in single-group interrupted time series analysis","volume":"23","author":"Linden","year":"2017","journal-title":"J Eval Clin Pract"},{"key":"2021121021250832400_B27","unstructured":"Children\u2019s Hospital Colorado. Clinical pathway: urinary tract infection (UTI). 2017. Available at: https:\/\/www.childrenscolorado.org\/globalassets\/healthcare-professionals\/clinical-pathways\/urinary-tract-infection.pdf. Accessed June 10, 2019"},{"issue":"6","key":"2021121021250832400_B28","doi-asserted-by":"crossref","first-page":"e20163026","DOI":"10.1542\/peds.2016-3026","article-title":"Reaffirmation of AAP clinical practice guideline: the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2-24 months of age","volume":"138","author":"Subcommittee on Urinary Tract Infection","year":"2016","journal-title":"Pediatrics"},{"issue":"3","key":"2021121021250832400_B29","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1136\/amiajnl-2010-000066","article-title":"Improving the utilization of admission order sets in a computerized physician order entry system by integrating modular disease specific order subsets into a general medicine admission order set","volume":"18","author":"Munasinghe","year":"2011","journal-title":"J Am Med Inform Assoc"},{"issue":"7","key":"2021121021250832400_B30","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.ijmedinf.2005.07.040","article-title":"Utilization of evidence-based computerized order sets in pediatrics","volume":"75","author":"McAlearney","year":"2006","journal-title":"Int J Med Inform"},{"issue":"6","key":"2021121021250832400_B31","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2013-3875","article-title":"Pediatric medical complexity algorithm: a new method to stratify children by medical complexity","volume":"133","author":"Simon","year":"2014","journal-title":"Pediatrics"},{"issue":"5","key":"2021121021250832400_B32","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.acap.2018.02.010","article-title":"Development and validation of the Pediatric Medical Complexity Algorithm (PMCA) version 3.0","volume":"18","author":"Simon","year":"2018","journal-title":"Acad Pediatr"},{"key":"2021121021250832400_B33","doi-asserted-by":"crossref","first-page":"S240","DOI":"10.1542\/peds.2008-1285D","article-title":"Rationale and design issues of the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study","volume":"122","author":"Keren","year":"2008","journal-title":"Pediatrics"},{"issue":"5","key":"2021121021250832400_B34","doi-asserted-by":"crossref","first-page":"e20172497","DOI":"10.1542\/peds.2017-2497","article-title":"Antibiotic allergy in pediatrics","volume":"141","author":"Norton","year":"2018","journal-title":"Pediatrics"},{"issue":"9","key":"2021121021250832400_B35","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.ajem.2015.04.067","article-title":"Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED","volume":"33","author":"Percival","year":"2015","journal-title":"Am J Emerg Med"},{"issue":"12","key":"2021121021250832400_B36","first-page":"829","article-title":"An ambulatory antimicrobial stewardship initiative to improve diagnosis and treatment of urinary tract infections in children","volume":"45","author":"Walters","year":"2019","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"22","key":"2021121021250832400_B37","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1001\/jama.2013.6287","article-title":"Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial","volume":"309","author":"Gerber","year":"2013","journal-title":"JAMA"},{"issue":"9","key":"2021121021250832400_B38","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jama.1995.03530090032018","article-title":"Changing physician performance. A systematic review of the effect of continuing medical education strategies","volume":"274","author":"Davis","year":"1995","journal-title":"JAMA"},{"issue":"2","key":"2021121021250832400_B39","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1002\/chp.21290","article-title":"The impact of CME on physician performance and patient health outcomes: an updated synthesis of systematic reviews","volume":"35","author":"Cervero","year":"2015","journal-title":"J Contin Educ Health Prof"},{"issue":"3","key":"2021121021250832400_B40","doi-asserted-by":"crossref","first-page":"e20170441","DOI":"10.1542\/peds.2017-0441","article-title":"Trends in antibiotic use by birth season and birth year","volume":"140","author":"Kinlaw","year":"2017","journal-title":"Pediatrics"},{"issue":"5","key":"2021121021250832400_B41","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.cmi.2018.11.002","article-title":"The quality of studies evaluating antimicrobial stewardship interventions: a systematic review","volume":"25","author":"Schweitzer","year":"2019","journal-title":"Clin Microbiol Infect"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2019-2503\/1078890\/peds_20192503.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2019-2503\/1078890\/peds_20192503.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T01:10:39Z","timestamp":1695863439000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/145\/4\/e20192503\/36944\/Improving-Antibiotic-Prescribing-for-Pediatric"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,1]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4,1]]},"published-print":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2019-2503","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,1]]},"article-number":"e20192503"}}