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Electronically delivered feedback reduces antibiotic prescribing for RTIs

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February 26, 2019

Electronically delivered prescribing feedback led to “moderate” reductions in unnecessary antibiotic prescribing for respiratory tract infections during a study conducted among general practitioners in the United Kingdom, researchers said.

“Overuse of antibiotics in medical practice is contributing to the emergence of antimicrobial drug resistance,” Martin C. Gulliford, FFPH, MA, professor of public health at King’s College London, and colleagues wrote.

“General practice and ambulatory care account for nearly three-quarters of all antibiotic prescribing, with respiratory tract infections (RTIs) representing the largest single group of indications for antibiotic treatment, including cough, acute bronchitis, common colds, otitis media, sinusitis, and sore throat,” they wrote. “Antibiotic treatment generally has little if any effect on the severity or duration of RTI symptoms, is commonly associated with side effects, and encourages patients to reconsult in future episodes.”

Gulliford and colleagues performed an open-label, two-arm, cluster randomized controlled trial at 79 U.K. general practices between Nov. 11, 2015, and Aug. 9, 2016, randomly assigning each practice to either the antimicrobial stewardship intervention or standard care. According to the study, practices in the intervention group received a training webinar and automated monthly feedback reports of their antibiotic prescribing for RTIs, and were given online access to electronic decision support tools.

According to the results, by the end of the follow-up period on Aug. 9, 2017, Gulliford and colleagues determined that the electronically delivered interventions resulted in a 12% reduction in antibiotic prescribing for RTIs in adults.

The trial included 41 antimicrobial stewardship intervention practices and 38 usual care practices. Results showed unadjusted and adjusted rate ratios for antibiotic prescribing of 0.89 (95% CI, 0.68-1.16) and 0.88 (95% CI, 0.78-0.99), respectively. Gulliford and colleagues calculated rates of 98.7 prescriptions per 1,000 patient years for the antimicrobial stewardship intervention group, equaling 31,907 prescriptions; and 107.6 prescriptions per 1,000 patient years for usual care, equaling 27,923 prescriptions. They determined prescribing reductions were mostly seen in patients aged 15 to 84 years old, with one antibiotic prescription per year avoided for every 62 patients.

“Although the absolute impact is moderate, it is likely to be important for public health in the drive to reduce antibiotic prescribing and the risks of antimicrobial resistance,” they concluded. “We caution that the intervention might not be effective at reducing antibiotic use for children or people aged 85 or older. Interventions using data from electronic health records might be used to promote antimicrobial stewardship in primary care and might be readily scaled up. The needs of very young or old patients need specific consideration. Our trial results also suggest the need for further research into the safety of reduced prescribing.” – by Caitlyn Stulpin

Disclosure: The authors declare support from the National Institute for Health Researchers.

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