Best Antibiotic Therapy for Acute Otitis Media in Children: A Primary Care and Stewardship Collaboration

Presenter:Alec Wesolowski, PharmD, BCIDP

 Acute otitis media (AOM) is a major driver of outpatient antibiotic use, with broad-spectrum agents and prolonged treatment remaining common despite guideline recommendations favoring narrower-spectrum therapy and shorter courses. 

A quality improvement (QI) initiative sought to improve antibiotic prescribing among medically underserved children receiving care across multiple pediatric sites within a Federally Qualified Health Center. Evidence-based AOM order sets were implemented in the electronic health record (EHR), followed by targeted prescriber education. Among 7,698 encounters involving children <18 years, order set utilization increased from 8.3% to 36.3% following targeted education (p < 0.01). Amoxicillin prescribing increased from 74.7% at baseline to 79% after order set implementation and 80.8% after education, whereas cefdinir use declined from 8.5% to 4.9% to 2.6% across the same periods. Among children >2 years, antibiotic courses lasting <7 days increased from 37.9% to 65.2% to 70.9% across the three periods.

The findings indicate that combining evidence-based order sets with targeted education improved antibiotic selection and treatment duration, supporting collaboration between antimicrobial stewardship teams and outpatient pediatric practices to promote equitable, evidence-based prescribing.

Improving Influenza Vaccination in the Pediatric Emergency Department

Presenter:Danielle Casher, MD MSHQ

 Declining influenza vaccination rates have created an opportunity for pediatric emergency departments (EDs) to provide immunization to children who may face barriers to routine primary care. This quality improvement (QI) project aimed to increase influenza vaccinations administered in the ED from 69 during the 2024–2025 season to 500 during the 2025–2026 season, particularly to improve access for families experiencing barriers related to poverty, racism, and limited primary care availability. 

Process mapping and key driver analysis identified workflow limitations, parental vaccine hesitancy, time constraints, cultural barriers, and incomplete vaccination records in the electronic health record (EHR). Interventions included staff education, EHR reminders, patient- and staff-facing flyers, monthly progress reviews, and incorporation of influenza vaccination into the sedation order set for children undergoing sedated procedures in the ED. During the 2025–2026 season, 520 children received influenza vaccination, representing a nearly ten-fold increase from the previous season. The initiative also improved cultural acceptance of vaccination within the ED. 

These findings support the ED as a practical setting for opportunistic immunization that can complement primary care and pharmacy programs, particularly by providing access during evenings, weekends, and holidays. Sustainability efforts will include vaccination orders for low-acuity patients and universal immunization screening during triage and rooming.

Expanding Influenza Vaccine Access Among Families in the Emergency Department

Presenter:Shannon H. Baumer-Mouradian, MD
 

Family members accompanying pediatric emergency department (PED) patients represent a potential missed opportunity for influenza vaccination, particularly when access to routine medical care is limited. Building on an ED-based influenza vaccination program sustained since 2018, this pilot adapted the existing model into a mobile PED Family Vaccine Clinic and assessed implementation outcomes, clinical reach, and financial feasibility. 

The Modified Approach to Intervention Mapping (IM-Adapt) guided adaptations developed by an interdisciplinary team of nursing, pharmacy, and PED provider leaders, with Plan-Do-Study-Act cycles used during a 10-week pilot conducted Monday–Friday, 10am–6pm, in a single tertiary care PED. Children and adults >6 months accompanying lower-acuity patients (triage levels 2–5) who were unvaccinated for influenza were eligible. Among 3,903 individuals, 56% of ED families were screened, 70% were eligible, and 19% of eligible individuals (n=519) received vaccination. Eligible adults most commonly declined because of concerns about out-of-pocket costs. Vaccinated individuals ranged from 6 months to 75 years. The pilot had a small negative direct financial margin of -3,490.42, with hospital leadership committing financial support beyond grant funding. 

The findings support the clinic as a feasible approach to expanding vaccination access within the PED, with ongoing collaboration to facilitate free adult vaccination for eligible individuals.

Leveraging A Novel Informatics Strategy to Optimize Antimicrobial Stewardship in Children’s Surgery Hospital: NYU Langone Health

Presenter:Anna Lieberman, MD, MPH 

 Antimicrobial stewardship programs (ASPs) may face resource constraints when applying prospective auditing, provider feedback, and data visualization across large pediatric surgical volumes. This quality improvement initiative assessed whether a customized informatics framework could strengthen perioperative antimicrobial stewardship for children’s surgery. A five-stage approach included institutional guideline development, compliance reference table creation, automated compliance assessment, real-time provider feedback, and dynamic data visualization. 

The institutional guideline was adapted from the 2024 American College of Surgeons (ACS) surgical antimicrobial prophylaxis (SAP) recommendations and tailored to local antibiograms. From February 2025–March 2026, weekly electronic health record queries and automated Python scripting assessed SAP compliance for National Surgical Quality Improvement Program (NSQIP)-qualifying procedures in children <18 years. Among 8,816 surgical cases over 14 months, 1,419 NSQIP-qualifying cases were reviewed by a single ASP team member in minutes, achieving 91% compliance with institutional SAP guidelines. 17 emails were sent to surgical providers regarding non-compliant cases. Antimicrobial use in low-risk clean cases decreased by 64% compared with pre-intervention utilization. 

The findings indicate that customized informatics tools can expand ASP auditing capacity with limited resources while supporting provider feedback and improved perioperative antimicrobial utilization.

The Rising of Congenital Syphilis and Its Impact on Prematurity: A Population-Based Study in Texas

Presenter:Vidhya Ravichandran, MD

The rising incidence of congenital syphilis (CS) in the United States has increased concern about its neonatal consequences, including prematurity and healthcare utilization. This retrospective population-based cohort study analysed 3,277,817 newborn admissions recorded in the Texas Inpatient Public Use Data File from 2016 to 2024, including 4,015 (0.12%) with CS identified using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes A50x. 

Preterm birth was more frequent among infants with CS than those without CS (30.0% vs. 13.6%, p<0.0001), while CS prevalence was 2.7 times higher among preterm than term newborns (0.27% vs. 0.10%, p<0.0001). CS disproportionately affected Hispanic (50.3%) and Black (22.4%) newborns (p<0.0001). Medicaid covered 72.8% of affected infants, compared with 20% with private insurance and 6.7% who were uninsured (p<0.0001). CS cases increased from 226 in 2016 to 670 in 2024. Infants with CS also had longer birth hospitalizations (12.69 ± 14.77 vs. 3.61 ± 10.64 days, p<0.0001). 

Overall, CS was associated with greater prematurity and substantially longer hospitalization, alongside increasing case numbers and differences in insurance coverage.

Association between Practice-level Telemedicine Use and Antibiotic Prescribing in Primary Care Practices

Presenter:Alexander Fiks, MD, MSCE

Concerns remain that telemedicine (TM) may contribute to antibiotic overuse in children, although the relationship between practice-level TM use and prescribing patterns is unclear. This retrospective longitudinal study analysed 2021–2024 electronic health record data from 1,265 United States pediatric and family medicine primary care practices, encompassing 2,308,349 acute respiratory tract infection (ARTI) visits among children <18 years old. 

Among practices with no TM use, 43% of ARTI visits resulted in an antibiotic prescription, with 33.24 ARTI visits and 14.44 antibiotic prescriptions per 100 active patients per year. After adjustment for patient and practice characteristics, each additional TM visit per month per 100 active patients was associated with lower odds of antibiotic prescribing at ARTI visits (OR 0.984, 95% CI 0.978–0.989). However, higher practice-level TM use was associated with increased ARTI visit occurrence (RR 1.128, 95% CI 1.125–1.131) and antibiotic prescribing among all active patients (RR 1.117, 95% CI 1.111–1.122). 

Thus, greater TM use was associated with lower antibiotic use per ARTI visit but a higher overall volume of ARTI visits and antibiotic prescriptions.

Prescribing Appropriate Antibiotics for Acute Respiratory Conditions: A Pediatric Urgent Care Quality Improvement Project with the Department of Health

Presenter:John J. Santos, MD, MBA

Outpatient antibiotic use accounts for 70–80% of antibiotic use in the United States, making outpatient antimicrobial stewardship (AMS) an important target for reducing inappropriate prescribing for respiratory infections. Seattle Children’s Urgent Care (UC), with over 40 providers and 65,000+ annual visits, implemented the Prescribing Appropriate Antibiotics for Acute Respiratory Conditions (PAAARC) Toolkit during Fiscal Year (FY) 2025 (October 2024–September 2025). 

The intervention incorporated AMS education, a Tableau dashboard displaying group and individual Healthcare Effectiveness Data and Information Set (HEDIS) Antibiotic Utilization for Respiratory Conditions (AXR) data, monthly de-identified peer-comparison emails, bilingual educational materials, diagnostic and antibiotic review (DART) training, and targeted discussions with higher-prescribing providers. The antibiotic prescribing rate for acute respiratory conditions decreased from 39% in Q1 FY2025 to 28.3% by May 2025, with sustained improvement and reduced variability among providers. The highest monthly email read rate exceeded 50%, indicating moderate engagement. 

Although diagnostic-level data and chart review were unavailable, implementation of the PAAARC Toolkit was associated with lower prescribing rates and reduced inter-provider variability.

American Academy of Pediatrics (AAP) National Conference & Exhibition 2026, October 2–6, San Diego, California