YAFI Online Programming // Disease State Management and Drug Therapy

The Pharmacist's Role in Outpatient Pediatric Antibiotic Stewardship

Educational Objectives

After participating in this activity, pharmacists will be able to:

  • Apply knowledge to determine appropriate treatment recommendations based upon national guidelines for common outpatient pediatric infectious diseases
  • Discuss the impact of appropriate immunizations on the recommendations for patients presenting with common outpatient infectious diseases
  • Apply communication and workflow advice/tips to community pharmacy settings in order to improve antimicrobial practices
  • Discriminate among reasons creating an urgency for antibiotic stewardship
  • Detail how to educate patients and parents about common antibiotic adverse events and counsel on avoidance

After participating in this activity, pharmacy technicians will be able to:

  • Identify common repercussions of irrational antibiotic use in pediatrics
  • Describe the prescription and OTC products and processes most likely to be used when children have infections
  • Identify why and how to store and safely dispose of antibiotics
  • Discuss why patients and parents may need to be educated about issues other than antibacterial resistance

Session Offered

Release Date: July 20, 2018

Expiration Date: July 20, 2021

Course Fee

Pharmacist: $7
Pharmacy Tech: $4

Session Codes

18YC72-PFK44 Pharmacist

18YC72-ABC36 Pharmacy Technician

Accreditation Hours

2.0 hours of CE

Abstract

Traditionally considered an inpatient activity, antimicrobial stewardship is making inroads in the community. Pharmacists and pharmacy technicians need a good understanding of antimicrobial stewardship activities and how they apply to four common pediatric infections that may be viral or bacterial–acute otitis media, acute bacterial sinusitis, pharyngitis, and community acquired pneumonia. By increasing vigilance for antibiotic misuse and promoting appropriate vaccinations, pharmacy staff become activists in the fight against microbial resistance.

Accreditation Statements

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and pharmacy technicians are eligible to participate in this application-based activity and will receive up to 0.2 CEU (2 contact hours) for completing the activity, passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor on- line system and your participation will be recorded with CPE Monitor within 72 hours of submission

ACPE UAN:
0009-9999-18-072-H01-P
0009-9999-18-072-H01-T

Grant funding: None

Cost: $7 for pharmacists, $4 for pharmacy technicians

Initial Release Date: July 20, 2018
Expiration Date: July 20, 2021

To obtain CPE credit, visit the UConn Online CE Center

Use your NABP E-profile ID and the session code 18YC72-PFK44 for pharmacists or 18YC72-ABC36 for pharmacy technicians to access the online quiz and evaluation.

First- time users must pre-register in the Online CE Center. Test results will be displayed immediately and your participation will be recorded with CPE Mon- itor within 72 hours of completing the requirements.

For questions concerning the online CPE activities, email joanne.nault@uconn.edu

Faculty

Sonali Shah, BS, 2019 PharmD Candidate.

Jen Girotto, PharmD, Associate Clinical Professor.

Sara E. Miller, BS, 2019 PharmdD Candidate.

Jeannette Y. Wick, R,Ph., MBA, FASCP, Assistant Director, Office of Pharmacy Professional development, University of Connecticut.

Faculty Disclosure

Ms. Shah, Dr. Girotto, Ms. Miller, and Ms. Wick have no actual or potential conflicts of interest associated with this article.

Disclosure of Discussions of Off-label and Investigational Drug Use

This activity may contain discussion of off label/unapproved use of drugs. The content and views presented in this educational program are those of the faculty and do not necessarily represent those of the University of Connecticut School of Pharmacy. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Content

Introduction

Our faculty presents this continuing education activity in two parts. Part 1 covers common pediatric infections through the lens of antimicrobial stewardship. It discusses four common pediatric infections–acute otitis media, acute bacterial sinusitis, pharyngitis, and community acquired pneumonia–and educates pharmacy staff about current guideline recommendations that strive to reduce unnecessary antibiotic use.

Part 2 looks at antibiotic stewardship from a different angle. It recognizes that many patients need or want more than one reason to appreciate fully why prescribers may seem “stingy” with antibiotics. It also discusses antibiotic overuse and its potential repercussions to individual children and its proven affects on the environment and society at large.

The post-tests cover both parts in one document.

References

Full List of References

PART 1
FUNDAMENTALS OF ANTIMICROBIAL STEWARDSHIP FOR OUTPATIENT PEDIATRIC INFECTIOUS DISEASES

1. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States. April 23, 2013. https://www.cdc.gov/drugresistance/threat-report-2013/index.html. Accessed January 20, 2018.

2. Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core Elements of outpatient antibiotic stewardship. MMWR Recomm Rep 2016;65(No. RR-6):1–12.

3. Centers for Disease Control and Prevention. Core elements of outpatient antibiotic stewardship. Available at https://www.cdc.gov/antibiotic use/community/improvingprescribing/core-elements/core-outpatient-stewardship.html. Accessed Jaly 9, 2018.

4. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-99.

5. Amoxicillin/Clavulanate Potassium: Pediatric Dosing. (2018). In Micromedex (Columbia Basin College Library ed.) [Electronic version]. Greenwood Village, CO: Truven Health Analytics. Available at http://www.micromedexsolutions.com/. Access July 2, 2018.

6. Wald ER, Applegate KE, Bordley C, et al; American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262-e280.

7. American Academy of Pediatrics Statement of Endorsement. Management of community-acquired pneumonia (CAP) in infants and children older than 3 months of age. Pediatrics. 2011; 128 (6);e1677.

8. Bradley JS, Byington CL, Shah SS, et al; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):e25-76.

9. Centers for Disease Control and Prevention. Group A streptococcal (GAS) disease, United Sates, 2016. Available at https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html. Accessed June 30, 2018.

10. Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Available at http://www.idsociety.org/Guidelines/Patient_Care/IDSA_Practice_Gui delines/Infections_By_Organ_System81567/Lower/Upper_Respiratory/Streptococcal_Pharyngitis/. Accessed July 9, 2018.

11. Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. Available at https://www.cdc.gov/vaccines/schedules/hcp/imz/childadolescent.html. Accessed June 5, 2018.

12. Centers for Disease Control and Prevention. Post-streptococcal glomerulonephritis. September 16, 2016. Available at www.cdc.gov/groupastrep/diseases-public/post-streptococcal.html. Accessed July 7, 2018.

13. Rifadin (rifampin) complete prescribing information. Bridgewater, NJ; sanofi-aventis U.S. LLC: 2018.

14. Nijjer S, Gill J, Nijjer S. Effective collaboration between doctors and pharmacists. Hosp Pharmacist. 2008; 15:179-182.

16. Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a metaanalysis. Pediatrics. 2009;123(6):e1103-e1110. Oseltamivir Phosphate: Pediatric Dosing. (2018). In Micromedex (Columbia Basin College Library ed.) [Electronic version]. Greenwood Village, CO: Truven Health Analytics. Available at http://www.micromedexsolutions.com/. Access July 2, 2018.

17. McNulty C, Joshi P, Butler CC, et al. Have the public’s expectations for antibiotics for acute uncomplicated respiratory tract infections changed since the H1N1 influenza pandemic? A qualitative interview and quantitative questionnaire study. BMJ Open. 2012;2(2): e000674.

18. McNulty CAM, Boyle P, Nichols T, Clappison P, Davey P. The public’s attitudes to and compliance with antibiotics. J Antimicrob Chemother. 2007;60(Suppl 1):i63–i68.

19. Amoxicillin: Pediatric Dosing. (2018). In Micromedex (Columbia Basin College Library ed.) [Electronic version]. Greenwood Village, CO: Truven
Health Analytics. Available at http://www.micromedexsolutions.com/. Accessed July 2, 2018.

20. Cefdinir: Pediatric Dosing. (2018). In Micromedex (Columbia Basin College Library ed.) [Electronic version]. Greenwood Village, CO: Truven
Health Analytics. Available at http://www.micromedexsolutions.com/. Accessed July 2, 2018.

21. Doxycycline Calcium: Pediatric Dosing. (2018). In Micromedex (Columbia Basin College Library ed.) [Electronic version]. Greenwood Village, CO: Truven Health Analytics. Available at http://www.micromedexsolutions.com/. Accessed July 2, 2018.

22. Levofloxacin: Pediatric Dosing. (2018). In Micromedex (Columbia Basin College Library ed.) [Electronic version]. Greenwood Village, CO: Truven Health Analytics. Available at http://www.micromedexsolutions.com/. Accessed July 2, 2018.

23. Clindamycin Hydrochloride: Pediatric Dosing. (2018). In Micromedex (Columbia Basin College Library ed.) [Electronic version]. Greenwood Village, CO: Truven Health Analytics. Available at http://www.micromedexsolutions.com/. Accessed July 2, 2018.

24. US Food and Drug Administration Center for Drug Evaluation and Research. “Drug Safety and Availability - FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects.” 2016. Available at www.fda.gov/Drugs/DrugSafety/ucm511530.htm. Accessed July 7, 2018.

25. US Food and Drug Administration, Center for Biologics Evaluation and Research. Drug safety and availability - FDA Drug Safety Communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. 2018. Available at www.fda.gov/Drugs/DrugSafety/ucm549679.htm. Accessed July 7, 2018.

26. Girotto J, Bennett N. Empiric outpatient antimicrobial guide. Connecticut Children's Medical Centers Antimicrobial Stewardship Program, 2017. Available at www.connecticutchildrens.org/wpcontent/uploads/2017/06/EmpiricOutpatientAntibiotic2016. Accessed July 7, 2018.

PART 2
DECREASING “RESISTANCE” TO ANTIBIOTIC STEWARDSHIP: THREE MORE REASONS

1. Kronman MP, Zhou C, Mangione-Smith R. Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections.
Pediatrics. 2014;134(4):956-965.

2. Centers for Disease Control and Prevention. Measuring outpatient antibiotic prescribing. Available at https://www.cdc.gov/antibioticuse/community/programs-measurement/measuring-antibioticprescribing.html. Accessed June 28, 2018.

3. Centers for Disease Control and Prevention. Core elements of outpatient antibiotic stewardship. 2016. Available at https://www.cdc.gov/mmwr/volumes/65/rr/rr6506a1.htm?s_cid=rr6506a1_e#F1_down. Accessed June 28, 2018.

4. Olsen SC, Smith S, Weissman SJ, Kronman MP. Adverse events in pediatric patients receiving long-term outpatient antimicrobials. J Pediatric Infect Dis Soc. 2015;4(2):119-125.

5. Kirkendall ES, Kouril M, Dexheimer JW, et al. Automated identification of antibiotic overdoses and adverse drug events via analysis of prescribing alerts and medication administration records. J Am Med Inform Assoc. 2017;24(2):295-302.

6. Shehab N, Lovegrove MC, Geller A, et al. US emergency department visits for outpatient adverse drug events, 2013-2014. JAMA. 2016;316(20):2115-2125.

7. Serranti D, Montagnani C, Indolfi G, et al. Antibiotic induced liver injury: what about children? J Chemotherapy. 2013;25(5):255-272.

8. Valeyrie-Allanore L, Sassolas B, Roujeau JC. Drug-induced skin, nail and hair disorders. Drug Safety. 2007;30(11):1011-1030.

9. Wick JY, Zanni GR. Skin tears: Prevention and treatment. Consult Pharm. 2008;23(7):508-518.

10. Mowad CM. Contact allergens of the year. Adv Dermatol.2004;20:237-55.

11. Centers for Disease Control and Prevention. Office-related antibiotic prescribing for persons aged ≤14 years United States, 1993-1994 to 2007-2008. 2011. Available at https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a1.htm. Accessed June 28, 2018.

12. National Capital Poison Center. Antibiotics: Overdose vs Misuse. Available at https://www.poison.org/articles/2012-oct/antibioticsoverdose-vs-misuse. Accessed June 28, 2018.

13. Shea, KM. Antibiotic Resistance: What is the Impact of Agricultural Uses of Antibiotics on Children’s Health? Pediatrics. 2003;112(1):253-257.

14. Food and Drug Administration. Guidance for Industry #213. 2013. Available at https://www.fda.gov/downloads/AnimalVeterinary/GuidanceCompli
anceEnforcement/GuidanceforIndustry/UCM299624.pdf Accessed June 28, 2018.

15. Centers for Disease Control and Prevention. Antibiotic resistance from the farm to the table.; 2017. Available at https://www.cdc.gov/foodsafety/pdfs/ar-infographic-508c.pdf. Accessed June 30, 2018.

16. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in The United States. 2013. Available at https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed June 30, 2018.

17. Consumer Reports. More Fast-Food Restaurants Are Serving ‘No Antibiotic’ Meat. 2016. Available at https://www.consumerreports.org/food-safety/more-fast-foodrestaurants-serving-no-antibiotic-meat/. Accessed June 30, 2018.

18. Nedelman M. Restaurant report card: What's in your fast food meat? CNN. September 28, 2017. Available at https://www.cnn.com/2017/09/27/health/fast-food-antibioticsgrades/index.html. Accessed Ju;y 3, 2018.

19. Cook H. Most grocery store meat contains antibiotic-resistant bacteria: 4 things to know. Available at https://www.beckershospitalreview.com/quality/most-grocery-storemeat-contains-antibiotic-resistant-bacteria-4-things-to-know.html. Accessed July 3, 2018.

20. Food and Drug Administration. Extralabel Use and Antimicrobials. 2018. Available at https://www.fda.gov/AnimalVeterinary/SafetyHealth/AntimicrobialResistance/ucm421527.html. Accessed June 30, 2018.

21. Grenni P, Ancona V, Caracciolo AB. Ecological effects of antibiotics on natural ecosystems. Microchemical J. 2018;136(1): 25-39.

22. Lood R, Erturk G, Mattiasson B. Revisiting antibiotic resistance spreading in wastewater treatment plants. Front Microbiol. 2017;8(2298):1-7.

23. Fleming-Dutra KE, Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315(17): 1864-1873.

24. Goggin K, Bradley-Ewing A, Myers AL, et al. Protocol for randomized trial of higher versus lower intensity patient-provider communication interventions to reduce antibiotic misuse in two paediatric ambulatory clinics in the USA. BMJ Open. 2018; 8(5):e020981.