Reducing Antibiotic Use by Implementation of Stewardship in Primary and Urgent Care

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

• Ages 6 months to 12 years
• All sexes
• No healthy volunteers
• Child

Study population: In two years, the project team will reach all 121,000 children 6 months to 12 years of age seen at 288,000 encounters for ARTIs at the Primary Care Practices and Urgent Care locations across the CHOP primary care and urgent care network.

Trial locations and contacts

1 site in 1 country.

About this study

Conditions

Community Acquired Pneumonia (CAP), Sinusitis, Strep Pharyngitis, Acute Otitis Media (AOM)

Being tested

Online Educational Modules, Prescribing Feedback Reports, Clinical Decision Support, Live, hybrid in-person and online educational sessions

Keywords

Antibiotics, Antimicrobial Stewardship

Medical subject headings

Community-Acquired Pneumonia, Sinusitis, Otitis Media

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

• Online Educational ModulesOther

  Online educational modules for clinicians that describe optimal antibiotic use and provide strategies to communicate with families about antibiotic prescribing for ARTIs. Modules are assigned through CHOP's internal learning website and assigned to every single primary care provider.

• Prescribing Feedback ReportsOther

  Prescribing feedback reports distributed quarterly that show clinicians how their prescribing and Group A Strep testing compares to their peers and to professional guideline recommendations. Will include metrics of overall prescribing and show choice and duration for antibiotics given ear infections, Strep throat, sinus infections, and pneumonia. The goal of the feedback reports is to show clinicians how often they are prescribing antibiotics, and when they do prescribe antibiotics are they doing so with right antibiotic and for the correct duration.

• Clinical Decision SupportOther

  Clinical decision support built into the electronic health record to help clinicians choose the right antibiotics for the right number of days. Using information from guidelines and clinical pathways created by CHOP to help providers continue to optimize their prescribing practices.

• Live, hybrid in-person and online educational sessionsOther

  Live, hybrid in-person and online educational sessions that explain the project, describe best prescribing practices and allow clinicians to talk directly with project team members. Study leaders visit all 31 practices across the network.

What is being measured

The primary outcome is the main question the study is designed to answer.

1. Antibiotic Prescribing Rates for Acute Respiratory Tract Infections (ARTIs)

   ARTIs as measured by overall rates of prescribing an antibiotic during clinic visits for an acute respiratory tract infection (URI) diagnosis, including both bacterial and viral URIs using the EHR (electronic health record). Goal is that antibiotics are prescribed at 40% or fewer ARTI visits. The optimal proportion of ARTI visits that should be associated with an antibiotic prescription is unknown. Baseline prescribing rates for antibiotics in the Network ranges from 34-61%. The target 40% rate is currently achieved by 10% of our practices with the lowest antibiotic prescribing.

   Measured: From start of implementation ramp up period to end of year 2 implementation

2. Change in overall optimal antibiotic prescribing rates for all bacterial ARTI encounters

   Changing overall antibiotic prescribing rates as measured by a composite of 1) narrow antibiotic selection and 2) shortest effective duration as a proportion of all antibiotics prescribed for each of the target diagnoses: Acute otitis media, Group A streptococcal pharyngitis, Acute sinusitis, and Pneumonia using EHR (electronic health record) data. This metric combines both narrow-spectrum antibiotic choice and optimal durations of therapy to comprehensively evaluate optimal antibiotic prescribing. At least 90% of antibiotics prescribed for ARTI are for optimal short duration and narrow spectrum antibiotics

   Measured: From start of implementation ramp up period to end of year 2 implementation

3. Broad- versus Narrow-Spectrum Antibiotic Prescribing

   Broad vs. Narrow-Spectrum antibiotic prescribing as measured by rates of broad-spectrum antibiotics as a proportion of all antibiotics prescribed within each of these diagnoses using the EHR (electronic health record):

   • acute otitis media
   • Group A streptococcal pharyngitis
   • acute sinusitis
   • pneumonia At least 90% of antibiotics prescribed for ARTI are for optimal narrow spectrum antibiotics.

   Measured: From start of implementation ramp up period to end of year 2 implementation

4. Shortest Effective Duration Antibiotic Prescribing

   Shortest effective duration measured by rates of prescribing the shortest effective duration of antibiotics as a proportion of all antibiotics prescribed within each of these diagnoses:

   • acute otitis media
   • Group A streptococcal pharyngitis
   • acute sinusitis
   • pneumonia At least 90% of antibiotics prescribed for ARTI are for the shortest effective duration of antibiotics. Optimizing durations of therapy will reduce overall antibiotic days and, therefore, decrease the overall antibiotic burden for children with ARTIs.

   Measured: From start of implementation ramp up period to end of year 2 implementation

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

1. First posted15 Oct 2025
2. Study start18 Feb 2025
3. Primary completionMay 2028 (estimated)
4. Study completionMay 2029 (estimated)

Resources

• Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
• Other trials for Community Acquired Pneumonia (CAP)Studies of the same condition, open and under way.
• More trials run by Children's Hospital of PhiladelphiaThe sponsor's other registered studies.
• What the trial phases meanHow a treatment moves from first tests in people to approval.

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.