Changes in antibiotic prescribing for children after a community-wide campaign

JAMA. 2002 Jun 19;287(23):3103-9. doi: 10.1001/jama.287.23.3103.


Context: Overuse of antibiotics has contributed to microbial resistance, compromising the treatment of bacterial infections. Very high levels (>50%) of antibiotic resistance among invasive Streptococcus pneumoniae have been documented in Knox County, Tennessee.

Objective: To determine the effectiveness of a community-wide intervention aimed at reducing inappropriate antibiotic use among children.

Design, setting, and participants: The Knox County Health Department led a multifaceted year-long campaign (May 1997 through April 1998) aimed at decreasing unnecessary antibiotic use among children. Tennessee's 3 other major urban counties (Shelby, Hamilton, and Davidson) did not conduct similar campaigns and served as controls. Evaluation included white and black children (aged <15 years) enrolled in Tennessee's Medicaid Managed Care Program in the 4 study counties, representing 36% of the study counties' children (464 200 person-years observed).

Intervention: Educational efforts were directed toward health care practitioners (primarily via peer leader presentations) and to the parents of young children and the public (primarily via printed materials).

Main outcome measure: The intervention-attributable effect on antibiotic use, defined as the excess percentage change in oral antibiotic prescription rates in Knox County between the 12-month preintervention and postintervention periods, relative to that of control counties.

Results: Antibiotic prescription rates declined 19% and 8% among Knox County and control county children, respectively, yielding an 11% intervention-attributable decline (95% confidence interval, 8%-14%; P<.001). The intervention-attributable decrease in prescription rates was greatest among children aged 1 to less than 5 years (among white children, 8% [P<.001]; among black children, 18% [P<.001]).

Conclusions: A community-wide educational intervention reduced antibiotic prescription levels among children in Knox County.

Publication types

  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use*
  • Black or African American
  • Child
  • Child, Preschool
  • Drug Prescriptions / statistics & numerical data
  • Drug Resistance
  • Drug Utilization / trends
  • Health Education*
  • Health Promotion*
  • Humans
  • Infant
  • Managed Care Programs
  • Medicaid
  • Outcome and Process Assessment, Health Care
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Practice Patterns, Physicians' / trends
  • Respiratory Tract Infections / drug therapy*
  • State Health Plans
  • Tennessee
  • United States
  • White People


  • Anti-Bacterial Agents