Study designs of evaluations included in the review
The authors did not state which types of study were eligible for inclusion, but prospective and retrospective designs were included, along with randomised and non-randomised controlled trials, interrupted time series, retrospective studies and cohort studies.
Specific interventions included in the review
Multiple types of interventions principally aimed at antimicrobial control were eligible. Interventions used during outbreaks were excluded. The review included: ‘focused education’, which provided prescribers with education on specific clinical issues via lectures, brochures and/or focus groups, one or more times during the study; ‘dynamic education’, where clinicians received feedback on their specific prescribing practices or ‘real time’ guidance for a specific scenario; ‘parent education’ provided via pamphlets, posters or video presentations; ‘antibiotic restriction’, which limited antibiotic choices or availability; and ancillary tests such as serum inflammatory markers or rapid viral diagnostic assays intended to guide initiation or completion of antibiotic treatment.
Participants included in the review
To be eligible, studies needed to be limited to paediatric patients (age 18 years or younger) or, if a study had both adults and children, the outcomes had to be analysed separately and children had to represent 50% or more of the sample. In studies where the intervention was targeted at practitioners, only those treating paediatric populations were included. The majority of the included studies were of ambulatory care practices and were carried out in hospital settings, such as the paediatric intensive care unit (ICU), nursery or neonatal ICU, and the emergency department.
Outcomes assessed in the review
Multiple outcomes were included, but all were mainly related to either a change in antibiotic usage or resistance. Studies that measured antibiotic resistance, utilisation or management as a secondary outcome were excluded. Most of the studies assessed more than one outcome; the most frequent outcome was antibiotic, use as determined by prescribing rates, antibiotic consumption or antibiotic costs. Approximately half of the studies measured clinical outcomes.
How were decisions on the relevance of primary studies made?
The authors did not state how the studies were selected for the review, or how many reviewers performed the selection.