https://doi.org/10.1177/0009922819870248 Clinical Pediatrics 1–9 © The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0009922819870248 journals.sagepub.com/home/cpj Original Article Introduction Around 75% of acute respiratory tract infections (ARTIs) are caused by viral infections. 1 However, antibiotics are still commonly prescribed in cases with signs and symp- toms suggesting viral infection. 2-7 Unnecessary use of antibiotics can lead to emergence of drug-resistant organisms 8 and increased medical costs 4 and can place patients at risk of drug side effects. 9 Implementing an antibiotic stewardship program (ASP) has been shown to increase appropriate antimicrobial use. 10,11 Previous studies 12,13 have shown that a combination of physician education together with auditing and feedback was effec- tive in reducing inappropriate prescription of antibiotics. In addition, public campaigns 14 and providing antibiotic use guidelines together with training 15 can also reduce inappropriate antibiotic prescriptions for common infec- tious diseases in ambulatory settings. In medical schools, where extensive training in the judicious use of antibiot- ics is provided, the rate of appropriate antibiotic use is expected to be high. However, few studies have been conducted to assess whether this perception is accurate and whether ASPs can further improve the appropriate- ness of antibiotic prescription. Our preliminary data regarding the antibiotic pre- scription rate for ARTI among pediatric clinics at Ramathibodi Hospital from January 2016 to December 2016 showed that antibiotics were prescribed in around 34.2% of the total visits. However, the percentage of appropriate antibiotic prescriptions is still unknown. The aim of this study was to evaluate the impact of an ASP on the appropriateness of antibiotic prescriptions 870248CPJ XX X 10.1177/0009922819870248Clinical PediatricsAoybamroong et al research-article 2019 1 Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Corresponding Author: Nopporn Apiwattanakul, Division of Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand. Email: np36@hotmail.com Impact of an Antibiotic Stewardship Program on Antibiotic Prescription for Acute Respiratory Tract Infections in Children: A Prospective Before-After Study Nalinee Aoybamroong, MD 1 , Worawit Kantamalee, MD 1 , Kunlawat Thadanipon, MD 1 , Chonnamet Techasaensiri, MD 1 , Kumthorn Malathum, MD 1 , and Nopporn Apiwattanakul, MD, PhD 1 Abstract We assessed the effectiveness of an antibiotic stewardship program (ASP) on antibiotic prescriptions for acute respiratory tract infection (ARTI) in a medical school. Our ASP included delivering an antibiotic use guideline via e-mail and LINE (an instant messaging app) to faculty staff, fellows, and residents, and posting of the guideline in examination rooms. Medical records of pediatric patients diagnosed with ARTI were reviewed to assess the appropriateness of antibiotic prescription. ASP could increase the rate of appropriateness from 78% (1979 out of 2553 visits) to 83.4% (2449 out of 2935 visits; P < .001). The baseline of appropriateness was higher in residents (95%) compared with fellows (82%) and faculty staff (75%). The ASP significantly increased the appropriateness only in faculty staff, especially in semiprivate clinics (75% to 83%, P < .001). In conclusion, our ASP increased appropriateness of antibiotic prescriptions for ARTI, with the greatest impact among faculty staff in semiprivate clinics. Keywords antibiotic stewardship, pediatric, medical school, physician education, acute respiratory tract infection