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Emanuel O. Doyne, MD; Mary Pat Alfaro, MS, RD; Robert M. Siegel, MD; Harry D. Atherton, MS; Pamela J. Schoettker, MS; Jeralyn Bernier, MD, MPH; Uma R. Kotagal, MBBS, MSc

Arch Pediatr Adolesc Med. 2004;158:577-583.

Background  Excessive and inappropriate use of antibiotics has been identified as a leading cause of the emergence of multiply resistant strains of pneumococci.

Objective  To examine the effects of academic detailing and a parental education program on community pediatricians' prescription of antibiotics for young children.

Methods  Physician leaders in study practices prepared educational modules and presented the modules to their practices. The control groups received only practice-specific report cards. Using a time-series analysis, we collected data on office visits and antibiotic prescriptions filled between May 1, 2000, and April 30, 2001 (baseline period), and between May 1, 2001, and April 30, 2002 (intervention period). Antibiotic prescription rate was defined as the ratio of antibiotic prescriptions filled to the number of office visits.

Results  The antibiotic prescription rate decreased to 0.82 (95% confidence interval, 0.71-0.95) of the baseline rate for the study group (6 practices) and to 0.86 (95% confidence interval, 0.77-0.95) of the baseline for the control group (5 practices). Similar patterns for antibiotic prescription rates were seen for study and control groups both before and after the intervention. Wide variations in prescription rates were observed among the practices, but, in general, the control practices had lower antibiotic prescribing rates during both the baseline and the intervention periods. Use of amoxicillin increased slightly in the study group and decreased slightly in the control group. The use of cephalosporins increased slightly in both groups.

Conclusion  Overall, academic detailing appeared to be no more effective in reducing antibiotic use than the practice-specific report cards alone.

From the Center for Health Care Policy and Clinical Effectiveness (Dr Kotagal, Mss Alfaro and Schoettker, and Mr Atherton) and Division of General and Community Pediatrics (Drs Doyne, Siegel, and Bernier), Cincinnati Children's Hospital Medical Center; and University of Cincinnati College of Medicine (Drs Kotagal, Doyne, Siegel, and Bernier), Cincinnati, Ohio.

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