Stewardship intervention tied to improved prescribing for kids' UTIs
A study conducted in a large healthcare system in Colorado found that a multicomponent intervention was associated with increased use of first-line antibiotics among children with uncomplicated urinary tract infections (UTIs), researchers reported today in Pediatrics.
The intervention at Kaiser Permanente Colorado (KPCO), instituted in April 2017 after a gap analysis identified frequent use of broad-spectrum antibiotics in the treatment of pediatric UTIs, involved several educational and process improvements aimed at key drivers of prescribing practices. In addition to developing new local clinical practice guidelines for pediatric UTIs that recommended the narrow-spectrum antibiotics cephalexin or sulfamethoxazole and trimethoprim as initial therapy, KPCO conducted a 2-hour educational session on the new guidelines, added them to a searchable online repository, and added a pediatric UTI algorithm and order set to the electronic health record.
To determine the impact of the intervention on prescribing for pediatric UTIs, KPCO researchers conducted an interrupted time-series analysis to compare prescribing before and after the implementation date (January 2014 to September 2018).
Among the 2,142 outpatient UTIs identified (1,636 pre-intervention and 506 post-intervention), after adjusting for clustering of UTIs within treating clinicians, the analysis found that the proportion of UTIs treated with first-line antibiotics increased from 43.4% pre-intervention to 62.4% post-intervention (P < .0001). Use of cephalexin increased from 28.9% to 53% (P < .0001), while use of the second-line antibiotic cefexime decreased from 17.3% to 2.6% (P < .0001). The changes were sustained for 1 year after the intervention. Researchers also observed a decrease in the average antibiotic treatment duration.
The authors note that the design of the study prevents them from inferring that the intervention caused the change in prescribing, and that it's not possible to determine which components were associated with the improvements.
They conclude, "Despite the limitations inherent in a nonexperimental study design, the methods and interventions developed in the current study may be informative to other learning health systems and other content areas when conducting organization-wide quality improvement initiatives."
Mar 3 Pediatrics abstract
Funding for new drug-resistant malaria treatments announced
The European & Developing Countries Clinical Trials Partnership (EDCTP) announced today that it will invest €21.9 million (US $24.5 million) to combat drug-resistant malaria in Africa and address other areas of urgent need in malaria treatment.
The EDCTP grant, awarded to the new PAMAfrica consortium led by the Medicines for Malaria Venture (MMV), will support a clinical trial for new combinations of compounds for treating complicated and uncomplicated malaria that fully active against artemisinin-resistant strains. Two other trials will assess a rapid-acting treatment for severe malaria and a new malaria treatment for malnourished babies.
MMV, drug maker Novartis, and other partners will provide an additional €22 million (US $24.6 million) over 5 years.
"Antimalarial drug resistance, originally seen in Southeast Asia, is being reported in Africa and may threaten current treatments," MMV Chief Scientific Officer Timothy Wells, PhD, said in a joint news release from EDCTP, MMV, and Novartis. "It is important to have new therapies that are active against this emerging threat of resistance."
The PAMAfrica consortium includes Novartis and research organizations from Burkina Faso, Gabon, Germany, Mozambique, Spain, and Uganda.
Mar 3 EDCTP, MMV, Novartis news release