- Design
- Single-centre quality improvement project with PDSA cycles
- Population
- Children discharged from a US paediatric ED with pneumonia or sinusitis
- Primary outcome
- Proportion prescribed guideline-recommended antibiotic duration
- Effect
- 13.1% to 64.8%; no change in 14-day return visits
A quality improvement report in Pediatrics, published on 13 October 2026, describes how one US paediatric emergency department set out to align discharge prescriptions with updated guidance: 3 to 5 days for uncomplicated community-acquired pneumonia and 5 to 7 days for acute bacterial sinusitis. At baseline only 13.1% of children received those durations.
The team introduced a clinical pathway, quick-reference codes, a discharge order set with the short duration built in, prescriber education and feedback. Over successive cycles the proportion rose to 64.8%, mainly driven by pneumonia, with sinusitis improving in parallel. Return visits for the same diagnosis within 14 days did not change.
The evidence for short courses comes from earlier randomised trials; this report adds the practical part — that prescribing habits shift when the default in the order set changes. Any department can copy the method.
- Prescribe 3 to 5 days of antibiotics for uncomplicated community-acquired pneumonia in children discharged home.
- Prescribe 5 to 7 days for acute bacterial sinusitis.
- Build the short duration into order sets and discharge templates so it becomes the default.
- Give families clear safety-netting on when to return.
- Audit durations and return visits to confirm the change is safe locally.
Why it matters
Most children were still getting longer courses than guidance supports; a changed default fixed that more than education alone.
Don't overread it
A single-centre before-and-after improvement project; the safety of short courses rests on earlier trials.
The statistics, in plain English
Quality improvement studies track a measure over time rather than compare randomised groups, so other changes in the same period could contribute. The unchanged return-visit rate is a reassurance, not proof of equal outcomes.
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