Pediatric practitioners campaign for antibiotic stewardship

Hundreds in the U.S. vow to foster education, prescribe more judiciously

October 26, 2015 (Boston, MA)—Pediatricians, physician assistants and nurses across the country this month have pledged to help eliminate the overuse of antibiotics in children, citing the many harms caused when the medications are prescribed inappropriately. Calling this overuse a threat to public health, the clinicians are devoting extra time educating parents and colleagues about the proper use for antibiotics.

Last year in the United States, there were more than 11.4 million unnecessary prescriptions for antibiotics written for children.  Among the harms linked to antibiotic overuse are multiple serious side effects and antibiotic resistance. But lesser known, antibiotic use has also been associated with chronic diseases such as asthma, diabetes and other autoimmune conditions.

The Lown Institute’s RightCare Alliance Pediatric Council initiated the campaign during RightCare Action Week (October 18-24), a week-long event for clinicians and others to demonstrate how healthcare delivery in the nation can be improved.

To show their support, clinicians are signing an online pledge to uphold antibiotic stewardship. Antibiotic stewardship transcends all specialties because primary care physicians, hospital-based physicians, specialists, nurse practitioners and physician assistants all prescribe antibiotics.

Specific examples of antibiotic stewardship include: “watchful waiting” for ear infections, avoidance of antibiotics for viral respiratory infections, and avoidance of prolonged durations of intravenous antibiotics in hospitalized patients after they have improved clinically.

“Antibiotics are important and useful medications for treating bacterial infections and preventing or minimizing spread of disease, said Alan Schroeder, MD, a pediatrician from Santa Clara, CA and a leader of the Pediatric Council. “But we believe antibiotics are being prescribed too often when they are clearly not needed.”

The pledge, which was disseminated via several pediatric group lists, includes a short reminder cheat sheet of 5 “Rights” for prescribing.

  • Right patient: Does the patient truly need an antibiotic for their infection? Do the benefits outweigh the risks?
  • Right drug: Choose the narrowest effective agent for the likely/proven infection; if starting broad, de-escalate as soon as possible
  • Right route: Only use IV route when necessary; transition to p.o. as soon as possible
  • Right dose: Optimize efficacy and compliance while minimizing toxicity
  • Right duration: Provide the shortest possible duration based on the best available evidence

“Sometimes it seems easier to just prescribe the antibiotic and move on to the next patient,” said Schroeder. “However, in most such cases we are causing more harm than good—to the patient, the population and the healthcare system.”

In addition, at hospital Grand Rounds, clinicians have begun routinely to point out antibiotic overuse as another way to help stem the tide of misuse.

About the RightCare Alliance Pediatric Council
The Council promotes right care for children by advancing evidenced-based care in pediatrics; highlighting instances in pediatrics where unnecessary care is commonly being delivered; providing a venue for advocacy to those who provide care for children and who are concerned about overtreatment, over-testing, over-diagnosis; and encouraging transparent discussions between families and providers surrounding risks and benefits of all proposed interventions.

About the Lown Institute

The Lown Institute, a nonprofit, action-driven think tank, is dedicated to transforming the culture of medicine and building a healthcare system that is affordable, effective, personal and just. The Institute was founded by renowned cardiologist and Nobel Peace Prize recipient, Bernard Lown, MD, and supports his vision for compassionate healthcare. Visit and follow us on Twitter at @LownInstitute.

Margie Coloian
Director of Communications