Impact of a Multi-Center Collaborative on Antibiotic Duration for Acute Respiratory Infections in Pediatric Urgent Care.

Creator(s)

• Amanda Nedved, Children's Mercy HospitalFollow
• Brian R. Lee, Children's Mercy HospitalFollow
• Luis E. Sainz, Children's Mercy Kansas CityFollow
• Matthew P. Kronman
• Adam L. Hersh
• Victoria Parente
• Rana F Hamdy
• Rana El Feghaly, Children's Mercy Kansas CityFollow
• For The Reducing Differences In Urgent Care Encounters For Antibiotic Choice ReDUCE Antibiotic Choice Quality Improvement Collaborative

Document Type

Article

Publication Date

10-8-2026

Identifier

DOI: 10.1093/jpids/piag099

Abstract

BACKGROUND: Updated guidance for common acute respiratory infections (ARIs) recommends shorter antibiotic durations. While stewardship efforts often focus on appropriate antibiotic selection, it remains unclear whether initiatives targeting first-line choice also influence duration.

METHODS: We conducted a secondary analysis of a national quality improvement collaborative including 92 pediatric urgent care sites across 9 organizations in 22 states and Washington, D.C. (April 2022-September 2024). The collaborative emphasized equitable first-line antibiotic selection; duration was not an explicit target. We included encounters for patients aged 6 months-18 years with ARI International Classification of Diseases-10 diagnoses resulting in an antibiotic prescription and excluded azithromycin. October 2023-April 2024 was defined as the intervention period during active Plan-Do-Study-Act cycles. The primary outcome was short-course prescribing (≤7 days). Multivariable, multilevel logistic regression models estimated odds of ≤7-day duration across time periods (pre-collaborative, intervention, post-collaborative) and sociodemographic groups.

RESULTS: Among 257 879 encounters, acute otitis media was most common (160 292; 62.2%). We saw an increase in ≤7-day duration prescribing from 33.4% pre-collaborative to 35.9% during the intervention and 37.8% post-collaborative. This increase was most notable for sinusitis (11.2% pre-collaborative to 33.9% post-collaborative). Compared with the pre-collaborative period, odds of ≤7-day duration were higher during intervention (aOR 1.22, 95% CI 1.18, 1.25, P <  0.001) and post-collaborative periods (aOR 1.31, 95% CI 1.27, 1.35, P <  0.001). Differences in duration were observed by race, language, and payor type.

CONCLUSIONS: During a collaborative focused on equitable first-line antibiotic selection, short-course prescribing increased, suggesting potential spillover to duration alongside broader secular trends. Persistent sociodemographic differences highlight the need to explicitly incorporate equity into outpatient stewardship efforts beyond antibiotic choice.

Journal Title

J Pediatric Infect Dis Soc

Volume

15

Issue

10

MeSH Keywords

Humans; Anti-Bacterial Agents; Respiratory Tract Infections; Child, Preschool; Infant; Child; Female; Male; Adolescent; Acute Disease; Antimicrobial Stewardship; Ambulatory Care; Quality Improvement; United States; Practice Patterns, Physicians'; Otitis Media

PubMed ID

42837306

Keywords

antimicrobial stewardship; duration; pediatric urgent care; quality improvement

Comments

Grants and funding

• Merck

Recommended Citation

Nedved AC, Lee BR, Sainz LE, et al. Impact of a Multi-Center Collaborative on Antibiotic Duration for Acute Respiratory Infections in Pediatric Urgent Care. J Pediatric Infect Dis Soc. 2026;15(10):piag099. doi:10.1093/jpids/piag099