Education, Decision Support, Feedback and a Minor Reward: A Novel Antimicrobial Stewardship Intervention in a Swedish Pediatric Emergency Setting


Sweden enjoys a favorable situation with regard to antimicrobial resistance. However, healthcare costs are expected to increase exponentially, along with increased morbidity and mortality, due to the emergence of resistant bacterial strains. Our aim was to design an antimicrobial stewardship program suitable for Scandinavian settings.


A quasi-experimental pre-post study was conducted in a Swedish pediatric emergency department, evaluating adherence to national guidelines for acute otitis media and acute tonsillitis. The program consisted of educational outreach, decision support, feedback, and a minor reward upon reaching a pre-defined adherence rate.


The largest impact, significant for both diagnoses, was on the practice of refraining from antibiotic use when recommended. The other variables evaluated showed no significant improvement for either condition; however, in most cases, pre-interventional adherence was already high.


This relatively easily implementable ASP intervention showed a significant effect on correctly refraining from the use of antibiotics. Previous interventions in Scandinavia either failed to accomplish this or have been more logistically difficult. The combination of education, decision support, email-based feedback and a minor reward, offers an alternative. Future research will be needed to assess whether the result is sustainable, as well as to identify additional barriers to the judicious use of antibiotics not addressed in this study.