RELAX: Reducing Length of Antibiotics For Children With Ear Infections

放松：减少耳部感染儿童的抗生素使用时间

• 批准号: 10708821
• 负责人: Holly Frost
• 金额: $ 45.65万
• 依托单位: DENVER HEALTH AND HOSPITAL AUTHORITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708821
• 关键词: RELAX; Reducing; Length; Antibiotics; Children

PROJECT SUMMARY/ABSTRACT: Acute otitis media (AOM) is the most commonly cited indication for antibiotics in children, accounting for 24% of all pediatric antibiotic prescriptions and affecting 60% of children by 3 years of age. For most children ≥ 2 years of age with AOM, 5-7 days, rather than 10 days, of antibiotics have been shown to be sufficient and result in fewer adverse drug events with similar failure and recurrence rates. Thus, national guidelines recommend short durations of antibiotics for non-severe AOM in this age group. Despite these recommendations, >94% of children ≥2 years of age are prescribed longer than recommended antibiotic durations and over 41% of antibiotic exposure days for AOM in this age group are likely unnecessary. In a recent pilot study that compared a low-cost High-intensity intervention with clinician education, individualized clinician audit and feedback with peer comparison and electronic health record (EHR) changes of prescription fields to a Low-intensity intervention with only EHR changes prescribing of recommended short antibiotic durations increased significantly (76% and 50%, absolute percentage). A definite study is needed to make appropriate recommendations on which intervention to implement, while minimizing resource utilization. The overarching goal of this study is to evaluate the effectiveness and implementation outcomes of two low-cost pragmatic interventions of different intensities to increase prescribing of recommended short antibiotic durations for AOM for children 2 years of age and older. A multi-center cluster randomized controlled trial using a hybrid type 2 implementation effectiveness design will be used to evaluate interventions. The High-intensity intervention will include clinician education, individualized clinician audit and feedback with peer comparison, and EHR changes of prescription fields, whereas the Low-intensity intervention will include clinician education and EHR changes. In total, 46 community-based clinics and/or urgent care centers across two distinct geographic regions in the United States will be randomized to one of the two interventions. The Practical Robust Implementation and Sustainability Model will be used to guide implementation and the Reach Effectiveness Adoption Implementation Maintenance framework will be used to evaluate outcomes. A mixed- methods approach will be used in the pre-implementation and evaluation phases and will utilize quantitative analyses, semi-structured interviews, focus groups, surveys, and cost analyses. National stakeholders at the American Academy of Pediatrics and the Centers for Disease Control and Prevention will assist with dissemination of findings and scaling of interventions.

项目摘要/摘要： 急性中耳炎（AOM）是儿童抗生素最常见的指示，占24％ 在所有小儿抗生素处方中，到3岁时影响60％的儿童。对于大多数儿童≥2 AOM的年龄为5-7天，而不是10天，已经证明是足够的，并且 导致较少的不良药物事件具有相似的失败和复发率。那是国家准则 建议在该年龄段的非重生AOM的抗生素短期。尽管如此 建议，> 94％的儿童≥2岁的儿童的处方比建议的抗生素更长 该年龄段的AOM的持续时间和超过41％的抗生素暴露天数可能是不必要的。在 最近的试点研究比较了低成本的高强度干预与临床教育，个性化的 临床审核和反馈以及同行比较和电子健康记录（EHR）的处方更改 低强度干预的领域，只有EHR更改的规定建议的短抗生素 持续时间显着增加（76％和50％，绝对百分比）。需要进行定义的研究以进行 适当的建议，以实施哪种干预措施，同时最大程度地减少资源利用率。这 这项研究的总体目标是评估两个低成本的有效性和实施结果 不同强度的务实干预措施增加了建议的短抗生素的处方 2岁及以上儿童AOM的持续时间。多中心群集随机对照试验使用 混合2型实施有效性设计将用于评估干预措施。高强度 干预措施将包括临床教育，个性化的临床审核和反馈以及同行比较， 和EHR处方场的变化，而低强度干预将包括临床教育 和EHR改变。总共有46个基于社区的诊所和/或紧急护理中心 美国的地理区域将被随机分为两种干预措施之一。实用 强大的实施和可持续性模型将用于指导实施和覆盖范围 有效性采用实施维护框架将用于评估结果。混合 方法方法将用于实现和评估阶段，并将使用定量 分析，半结构化访谈，焦点小组，调查和成本分析。国家利益相关者 美国儿科学会和疾病控制与预防中心将有助于 传播发现和干预措施的缩放。

项目成果

Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.

• DOI: 10.57264/cer-2023-0088
• 发表时间: 2023-11
• 期刊: Journal of comparative effectiveness research
• 影响因子: 2.1
• 作者: Keith A;Jenkins TC;O'Leary S;Stein AB;Katz SE;Newland J;Rinehart DJ;Gilbert A;Dodd S;Terrill CM;Frost HM
• 通讯作者: Frost HM