A Systems Approach to Antimicrobial Stewardship in Pediatric Urgent Care

In urgent or emergency care settings, antibiotics are often prescribed to children for presumed urinary tract infection (UTI) prior to receipt of the urine culture result. If that result is negative, antibiotics should be discontinued to avoid needless exposure to antibiotics. To ensure that discontinuation is achieved in these cases, one children's hospital care network implemented a quality improvement (QI) intervention, instituting a simple protocol for urine culture follow-up among urgent care patients.

The protocol entailed systematic review of urine culture results and multiple efforts to communicate the recommendation to continue or discontinue antibiotics to the patient's family (two attempts by phone on consecutive days followed by …