# Effect of Educational Activities on Pediatricians Prescribing Oral Antibiotics in Pediatric Emergency Rooms

## TL;DR

Educational workshops for pediatricians in Japan initially reduced antibiotic overprescription, but the effect faded over time, highlighting the need for ongoing stewardship.

## Contribution

Demonstrates the short-term effectiveness of educational workshops in reducing antibiotic overprescription by pediatricians.

## Key findings

- Antibiotic prescribing preferences for mild acute otitis media dropped from 39.4% to 16.4% immediately after a workshop.
- Overall oral antibiotic prescribing rates in emergency rooms decreased from 18.3% in 2017 to 12.2% in 2019.
- The effect of workshops on prescribing behavior was transient, with a return to higher rates over time.

## Abstract

Background: Analyses of global antibiotic prescribing trends have identified Japan as one of the countries with the highest rates of antibiotic overprescription in pediatric outpatient care, thus indicating the necessity of antimicrobial stewardship for pediatricians.

Methods: We conducted two educational workshops for pediatricians in October 2018 and October 2019 in Yamanashi Prefecture, Japan, and then surveyed their effect on preferences for antibiotic prescription rates using questionnaires. Antibiotic prescribing in two pediatric emergency rooms for three years was also evaluated through health insurance claims. The primary objective is to evaluate changes in prescribing preferences, and the secondary objective is to assess changes in monthly prescribing rates and antibiotic class-specific prescribing rates.

Results: Immediately before the first workshop, 39.4% (28/71) of respondents agreed with prescribing antibiotics for a hypothetical case of mild acute otitis media. This percentage decreased to 16.4% (9/55) in the post-workshop survey. However, one year later, just before the second workshop, 44.0% (22/50) of respondents agreed with prescribing antibiotics. The oral antibiotic prescribing rate in pediatric emergency rooms decreased from 18.3% (4836/26,484 patient visits) in the baseline year (2017) to 12.4% (2868/23,188) and 12.2% (2651/21,709) in 2018 and 2019, respectively. The prescribing rate of cephems among all prescribed antibiotics decreased from 53.8% to 46.4% and 43.4%, while that of semisynthetic penicillin increased from 26.7% to 34.7% and 35.1%, respectively. A transient reduction in seasonal prescribing rate was observed in the autumn of 2018 and 2019, aligning with the timing of the workshops.

Conclusions: Antibiotic prescribing preferences and behavior among pediatricians changed following the workshops. However, the impact of these workshops gradually diminished over time, underscoring the importance of sustained antimicrobial stewardship interventions.