Reducing antibiotic prescribing rates in young children in an outpatient primary care setting-a systemwide quality improvement initiative.

Objectives: To improve antimicrobial stewardship (AMS) and reduce unnecessary antibiotic prescriptions in young children in a British primary care setting. Methods: Forty-nine general practices in the South of England each hosted a 1 h in-house workshop, facilitated by trained local pharmacy professionals. This type of educational outreach approach using TARGET (Target Antibiotics Responsibly, Guidance, Education and Tools) antibiotic materials has previously been shown to reduce antibiotic dispensing in a UK primary care setting. The workshop included a review of antibiotic prescribing data, a presentation on paediatric AMS showcasing locally agreed paediatric prescribing guidelines and safety-netting resources from the Healthier Together website, and formulation of a local action plan. The primary outcome measure was total oral antibiotic prescriptions ('items') dispensed per 1000 patients aged under 5 years for the year after the workshop, compared with the previous year's dispensing. Results: The median prescribing rate for children under 5 years of age changed from a baseline of 48.9 per 1000 patients prior to the intervention to a new median monthly prescribing rate of 39.0 per 1000 patients following the intervention. There was no increase in paediatric presentations to primary care following the intervention. Conclusions: This low-cost intervention has the potential to reduce primary care antibiotic prescribing in children and we did not detect an increase in GP attendance rates after this intervention in our study. It could easily be rolled out nationwide.