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Pediatric Outpatient Antimicrobial Stewardship


U.S. Antibiotic Awareness Week is November 18th-24th. During this observance, SIDP is highlighting members who promote optimal antibiotic use and combat the threat of antibiotic resistance in impactful and innovative ways. This blog features Dr. Bethany Wattles and her role as pediatric antimicrobial stewardship researcher. 

Briefly describe your daily role as an antimicrobial stewardship researcher

Our pediatric research unit, the Child and Adolescent Health Research Design and Support Unit (CAHRDS) is a collaboration between the University of Louisville Department of Pediatrics and Norton Children’s Hospital. The CAHRDS unit exists to improve effectiveness, quality, safety, and delivery of health care and promote optimal health for all children in Kentucky. Within this unit, myself and other clinicians and researchers have a specific interest in improving outpatient antibiotic prescribing to children.

A large portion of our work is through a State University Partnership contract with Kentucky Medicaid to improve antibiotic prescribing to Medicaid children. We use healthcare claims data to analyze antibiotic prescribing trends and design and implement research and quality improvement initiatives to improve prescribing. We also deliver educational content to healthcare providers throughout the state and have created a statewide public education campaign called Kentucky Antibiotic Awareness.

What outpatient stewardship initiative are you most proud of that you have participated in or led?

Kentucky is consistently the 2nd highest prescribing state in the US, so we have a lot of room for improvement. Most outpatient stewardship efforts are focused within large healthcare organizations. However, in our research we have identified that the highest prescribing rates occur in rural areas of KY and by non-pediatric prescribers. Although it is more challenging, I am proud that our stewardship work is designed to involve all providers and patients, including higher-risk and more difficult to reach settings. For example, we are currently working to distribute individual feedback reports to all KY providers who prescribe antibiotics to children. This effort will include over 5,500 unique providers in all areas of Kentucky and across a variety of practice settings.

Additionally, our work has provided opportunities for collaboration both across the state and nationally. I am passionate about the idea that stewardship is best conducted as a team effort and I appreciate the opportunity to provide perspective as a pharmacist to groups and organizations that are traditionally physician-led.

What does "Being Antibiotics Aware" mean to you?

To me, “Being Antibiotics Aware” means recognizing that each time an antibiotic is used, it could lead to harm. Whether considering antibiotics for treatment of the common cold, to prevent surgical site infections, or to treat a life-threatening infection - we as providers and patients must consider the potential benefit vs. risk with each treatment decision. 

What is one pearl you have for all pharmacists to help them be antibiotic stewards?

Everyone can play a role in promoting outpatient antibiotic stewardship. Whether you are taking your own child to a sick visit or assisting with a quality improvement project - there is so much room for opportunity that everyone can and should get involved!

Bethany Wattles, PharmD, MHA


Assistant Professor of Pediatrics and Clinical Research Pharmacist


Child and Adolescent Health Research Design and Support (CAHRDS) Unit

University of Louisville School of Medicine


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