Antibiotics
Changing Empirical Antibiotic Prescribing Patterns Through a Clinical Decision Support System in Outpatient Paediatric Care in Italy: A Multicentre, Quality-Improvement Study
By Brigadoi G, Boracchini R, Liberati C and 10 others.
Abstract
Background/objectives
Respiratory tract infections (RTIs) represent one of the most frequent reasons for antibiotic prescribing in paediatric primary care. Clinical decision support systems (CDSS) offer a strategy to promote guideline-concordant prescribing, but evidence from real-world implementation remains limited.
Methods
We conducted a cluster-level controlled before-and-after quality-improvement study among 15 family care paediatricians of an Italian paediatric primary care network. Antibiotic prescriptions for RTIs in children aged < 14 years were compared between November 2023-April 2024 and November 2024-April 2025 across three groups: CDSS only, CDSS plus multilingual caregiver leaflets, and no intervention. The CDSS, integrated into the software where health records were recorded, provided guideline-based treatment pathways and weight-based dosing. Episodes were identified via ICD-9-CM codes and validated free text in the Pedianet database; log-binomial regression estimated relative risk with 95% CI. Within-paediatrician correlation was accounted for in the analysis using a cluster-robust variance estimator.