{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:01:42Z","timestamp":1793671302983,"version":"4.5.1"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program\u2019s effectiveness for reducing outpatient antibiotic prescribing for ARTI visits.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to &amp;lt;11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Among 72\u2009723 ARTI visits by 29\u2009762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90\u20130.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50\u20130.87) and sinusitis (aRR 0.59; 95% CI, 0.44\u20130.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83\u20131.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51\u20130.70).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2020-0038","type":"journal-article","created":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T12:25:29Z","timestamp":1596457529000},"source":"Crossref","is-referenced-by-count":98,"title":["Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness"],"prefix":"10.1542","volume":"146","author":[{"given":"Matthew P.","family":"Kronman","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington;"},{"name":"Seattle Children\u2019s Research Institute, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Gerber","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Grundmeier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington;"},{"name":"Seattle Children\u2019s Research Institute, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Communication, College of Liberal Arts and Sciences, Portland State University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Heritage","sequence":"additional","affiliation":[{"name":"Department of Sociology, University of California, Los Angeles, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Stout","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Burges","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Hedrick","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Warren","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Shalowitz","sequence":"additional","affiliation":[{"name":"NorthShore University HealthSystem, Evanston, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura P.","family":"Shone","sequence":"additional","affiliation":[{"name":"Primary Care Research, American Academy of Pediatrics, Itasca, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Steffes","sequence":"additional","affiliation":[{"name":"Primary Care Research, American Academy of Pediatrics, Itasca, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Wright","sequence":"additional","affiliation":[{"name":"Primary Care Research, American Academy of Pediatrics, Itasca, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander G.","family":"Fiks","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"},{"name":"Primary Care Research, American Academy of Pediatrics, Itasca, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Mangione-Smith","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2020,9,1]]},"reference":[{"issue":"6","key":"2021121020313299000_B1","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1542\/peds.2011-1337","article-title":"Antibiotic prescribing in ambulatory pediatrics in the United States","volume":"128","author":"Hersh","year":"2011","journal-title":"Pediatrics"},{"issue":"17","key":"2021121020313299000_B2","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1001\/jama.2016.4151","article-title":"Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011","volume":"315","author":"Fleming-Dutra","year":"2016","journal-title":"JAMA"},{"issue":"4","key":"2021121020313299000_B3","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2014-0605","article-title":"Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections","volume":"134","author":"Kronman","year":"2014","journal-title":"Pediatrics"},{"issue":"3","key":"2021121020313299000_B4","first-page":"370","article-title":"Changes in US outpatient antibiotic prescriptions from 2011-2016","volume":"70","author":"King","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2021121020313299000_B5","unstructured":"Centers for Disease Control and Prevention. National action plan for combating antibiotic-resistant bacteria. Available at: https:\/\/www.cdc.gov\/drugresistance\/pdf\/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. 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