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  1. Pasquale Frisina,
  2. Jonathan Pletcher,
  3. Esther Munene,
  4. John Kolligian
  1. University Health Services, Princeton University, United States


Background Acute bronchitis is a leading cause of ambulatory care visits within the United States. Despite the well-established prevalence of viral etiologies among young adults, over-prescribing of antibiotics persists. This prescribing pattern is concerning because of microbial antibiotic resistance and adverse drug reactions. Therefore, we initiated a QI-study to drive antibiotic stewardship for acute uncomplicated bronchitis (AUB) within a university-based healthcare setting.

Objectives Apply common prescribing guidelines in an effort to reduce our antibiotic prescription rate for AUB to a level of 10% or less.

Methods The following QI-interventions were implemented, consistent with the IHI-Model for Improvement: (1) clinicians provided education to patients on viral respiratory infections, including a care plan and information on the potential harm from antibiotics; (2) clinicians employed the term “chest cold” for AUB in the absence of criteria indicating bacterial infection; and (3) antibiotic stewardship for AUB was included in peer chart reviews, including follow-up education to providers as needed.

Results The QI-interventions significantly reduced our antibiotic prescription rate from a baseline of 80% to a level of 5% (5 out of 91 charts) within one cycle of Plan-Do-Study-Act, Chi-square (1)=4.07, p<.05.

Conclusions Antibiotic stewardship related to AUB improved to 95% compliance with clinical guidelines through staff and patient education, and regular peer chart review. This effort is of particular importance in college health as this represents a unique opportunity to educate young adults, often novice consumers of healthcare, on the appropriate use of antibiotics.

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