2. Education Intervention in the Clinical Setting for Inappropriate Use of Antibiotics in Children Katie Butterfield

3. Problem Statement  Children are especially at risk, due to their age, of being overexposed to antibiotics. Experts estimate that up to 50 percent of antibiotic prescriptions written in the United States every year are unnecessary (Ross, H., 2014).  A study of almost 65,000 American children showed that 69 percent are exposed to multiple antibiotics before two years old (Ross, H., 2014).  Common illnesses like ear infections and respiratory illnesses are still being treated with antibiotics, regardless of updated guidelines that have been published that instruct to use alternate therapies to achieve success without the added risk of unnecessary antibiotics.

4. Included and Excluded Studies in Systematic Review 192 studies identified in initial survey 186 excluded 6 met inclusion criteria 3 low quality studies excluded 3 with score of 2 or higher – included in final analysis.

5. Included and Excluded Studies  Only include children and adolescents 6 months to 18 years of age  Only studies in English  Date range 1960-2013  No vaccination studies  Only U.S. studies

6. Results  Data collected from six studies that conducted Random Control Trials  Studies focused on educational programs for physicians and parents in the community and the clinics in the community  Data gathered includes antibiotic prescription rates and relationship between physician characteristics and antibiotic rate decreases

7. Results  No statistical significance between antibiotic prescription for common illnesses in children before implementation of education programs and after.  Some studies showed overall decline in prescription, statistics were low enough that they failed to reject the null hypothesis.  Did increase knowledge and concerns about inappropriate antibiotic prescription

8. Limitations  Number of clinics across communities  Random selection process of community participants  Several studies continued until no new themes emerged; surveys were given to all participants; yet only a small sample of physicians were interviewed  Studies were all performed in small communities, so race, ethnicity, and education levels were not collected.

9. Recommendations  Areas of suggested future investigation :  Longer-term studies with implementation of ongoing education for parents and clinicians about antibiotic guidelines and proper prescription  Study regarding specific education for parents and physicians focusing on implications of over-prescription of antibiotics in children – resulting in antibiotic-resistant bacteria and future complications  Studies similar to already existing ones but collecting variables like education level of parents, gender of physicians, income level of parents, race, and ethnicity