The burden of antimicrobial resistance is a significant public health challenge, especially in young children, driven by antibiotic misuse.

This study aimed to assess the impact of repeated prospective clinical audits, with a systematic feedback design, on enhancing antibiotic prescribing practices among outpatients visiting the Pediatric Emergency Department of a teaching hospital located in the north-eastern region of France.

We conducted a before-and-after study design over 13 months (2021–2023), performing clinical audits to assess antibiotic prescribing practices. The standards were based on guidelines from French scientific societies. We implemented a multimodal improvement plan, including regular meetings with prescribers. After each educational session, we reassessed antibiotic prescription patterns and provided rapid feedback to encourage timely adjustments.

Outpatients accounted for 79% of emergency visits. Over 13 months, we retained 1477 prescriptions. The distribution of diseases remained consistent throughout periods. The overall guideline adherence rate was 75% during the preintervention period and remained stable throughout the study. In situations where antibiotics were recommended, this rate was 51.6% at baseline and 50% in the postintervention period. Nonetheless, adherence to treatment initiation guidelines increased significantly, from 88.9% to 96.6%. Furthermore, the proportion of appropriate antibiotic selections increased from 82.2% to 93.2% ( p = 0.001). Additional analysis indicated a reduction in antibiotic consumption among pediatric outpatients during the study period.

These results show that implementing an antibiotic stewardship program in pediatric emergency departments can improve adherence to antibiotic guidelines. These findings support the need to expand antimicrobial stewardship programs in pediatric settings.