Impact of a Multi-Center Collaborative on Antibiotic Duration for Acute Respiratory Infections in Pediatric Urgent Care.

Abstract

Background: Updated guidance for common acute respiratory infections (ARIs) recommends shorter antibiotic durations. While stewardship efforts often focus on appropriate antibiotic selection, it remains unclear whether initiatives targeting first-line choice also influence duration.

Methods: We conducted a secondary analysis of a national quality improvement collaborative including 92 pediatric urgent care sites across 9 organizations in 22 states and Washington, D.C. (April 2022-September 2024). The collaborative emphasized equitable first-line antibiotic selection; duration was not an explicit target. We included encounters for patients aged 6 months-18 years with ARI International Classification of Diseases-10 diagnoses resulting in an antibiotic prescription and excluded azithromycin. October 2023-April 2024 was defined as the intervention period during active Plan-Do-Study-Act cycles. The primary outcome was short-course prescribing (≤7 days). Multivariable, multilevel logistic regression models estimated odds of ≤7-day duration across time periods (pre-collaborative, intervention, post-collaborative) and sociodemographic groups.

Results: Among 257 879 encounters, acute otitis media was most common (160 292; 62.2%). We saw an increase in ≤7-day duration prescribing from 33.4% pre-collaborative to 35.9% during the intervention and 37.8% post-collaborative. This increase was most notable for sinusitis (11.2% pre-collaborative to 33.9% post-collaborative). Compared with the pre-collaborative period, odds of ≤7-day duration were higher during intervention (aOR 1.22, 95% CI 1.18, 1.25, P < 0.001) and post-collaborative periods (aOR 1.31, 95% CI 1.27, 1.35, P < 0.001). Differences in duration were observed by race, language, and payor type.

Conclusions: During a collaborative focused on equitable first-line antibiotic selection, short-course prescribing increased, suggesting potential spillover to duration alongside broader secular trends. Persistent sociodemographic differences highlight the need to explicitly incorporate equity into outpatient stewardship efforts beyond antibiotic choice.