Summary: | Aim: Preventing unnecessarily long durations of antibiotic therapy is a key opportunity to reduce antibiotic
overuse in children 2 years of age and older with acute otitis media (AOM). Pragmatic interventions
to reduce durations of therapy that can be effectively scaled and sustained are urgently needed. This
study aims to fill this gap by evaluating the effectiveness and implementation outcomes of two low-cost
interventions of differing intensities to increase guideline-concordant antibiotic durations in childrenwith
AOM. Methods: The higher intensity intervention will consist of clinician education regarding guidelinerecommended
short durations of antibiotic therapy; electronic health record (EHR) prescription field
changes to promote prescribing of recommended short durations; and individualized clinician audit and
feedback on adherence to recommended short durations of therapy in comparison to peers, while the
lower intensity intervention will consist only of clinician education and EHR changes. We will explore
the differences in implementation effectiveness by patient population served, clinician type, clinical
setting and organization as well as intervention type. The fidelity, feasibility, acceptability and perceived
appropriateness of the interventions among different clinician types, patient populations, clinical settings
and intervention type will be compared. We will also conduct formative qualitative interviews with
clinicians and administrators and focus groups with parents of patients to further inform the interventions
and study. The formative evaluation will take place over 1.5 years, the interventions will be implemented
over 2 years and evaluation of the interventions will take place over 1.5 years. Discussion: The results of
this study will provide a framework for other healthcare systems to address the widespread problem of
excessive durations of therapy for AOM and inform national antibiotic stewardship policy development.
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