Acute otitis media (AOM) is the most common indication for antibiotics for Canadian paediatric patients. As the gatekeepers of safe and effective prescription pharmacotherapy, community pharmacists are well positioned to influence and optimize antibiotic use. The purpose of this project is to develop, implement, and evaluate an antimicrobial stewardship program in the community pharmacy setting that aims to optimize antibiotic use for AOM. This nonrandomized pre-post study includes children aged 6 months to 12 years presenting with an antibiotic prescription for AOM at two community pharmacies in Toronto, Ontario. Participants are excluded if they exhibit signs/symptoms of mastoiditis, have an additional indication for systemic antibiotics, or parents/guardians cannot consent in English. The multifaceted AMS intervention includes pharmacist education, a clinical decision support tool, a parent/guardian questionnaire, and individualized monthly audit and feedback with each pharmacist. Prescriptions are reviewed and adapted by the pharmacist to optimize congruence with 2016 Canadian Paediatric Society AOM guidelines. The primary outcome is the percentage change in guideline congruence attributable to pharmacist intervention. This study will provide insight into the opportunities and barriers of developing large-scale antimicrobial stewardship programs for community pharmacies.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
188
The multifaceted AMS intervention includes pharmacist education, a clinical decision support tool, a parent/guardian questionnaire, and individualized monthly audit and feedback with each pharmacist.
No active intervention
Shoppers Drug Mart #500
Toronto, Ontario, Canada
Shoppers Drug Mart #994
Toronto, Ontario, Canada
Change in guideline congruence
% change in guideline congruence for overall antibiotic prescriptions as attributable to pharmacist intervention before and after study intervention
Time frame: Pre-post study intervention (comparison of two 4-6 month periods)
Choice of antibiotic
% change in guideline congruence for choice of antibiotic before and after study intervention
Time frame: Pre-post study intervention (comparison of two 4-6 month periods)
Antibiotic dosing
% change in guideline congruence for antibiotic dose before and after study intervention
Time frame: Pre-post study intervention (comparison of two 4-6 month periods)
Antibiotic duration
% change in guideline congruence for antibiotic duration before and after study intervention
Time frame: Pre-post study intervention (comparison of two 4-6 month periods)
Acceptance of pharmacist recommendations
The percentage of pharmacist recommendations that were accepted by prescribers and parents/guardians (descriptive statistic)
Time frame: Post-intervention study arm (6 month period after start of intervention)
Balancing measure: resolution of AOM
The percent of cases with symptom resolution for AOM
Time frame: 7-14 days after antibiotics were dispensed
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