September 25, 2013
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Information campaign lowered antibiotic use in Italy

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A low-cost information campaign that targeted the public in Italy led to significant reductions in antibiotic use, according to recent study results.

"Rather than a 'top-down' style (pushy messages delivered by health authorities), we sought a social marketing approach using 'consumer' research and communication techniques to design messages that could be relevant, acceptable, appealing, and easy to understand and remember and put into practice for the target audience, to eventually influence behavior," Giulio Formoso, MPH, MPharm, an epidemiologist from Emilia-Romagna Regional Health and Social Care Agency in Bologna, Italy, and colleagues wrote.

Giulio Formoso, MPH, MPharm 

Giulio Formoso

The information campaign focused on the public and individual health threat of unnecessary antibiotic use, particularly antimicrobial resistance. The motto of the campaign was: "Antibiotics, solution or problem?" Campaign messages were included in posters, brochures and advertisements in local media, in addition to a newsletter on antibiotic resistance that targeted doctors and pharmacists.

A group of 13 general practitioners helped in the design of the message.

The campaign targeted residents of the Italian provinces of Modena and Parma (1,150,000 residents) from November 2011 to February 2012. Provinces in the same region where the campaign had not been implemented were chosen as control group (3,250,000 residents). The researchers examined the average change in prescribing rates for outpatients and outpatient expenditure on antibiotics in 5 months.

Average prescribing rates corresponded to an 11.9% decrease among outpatients residing in the intervention area and a 7.4% reduction among those in the control area compared with the same 5-month period in the previous year. There was a 3.2% reduction in antibiotic prescriptions across the rest of Italy. The researchers observed a greater decrease for prescription of penicillins resistant to beta-lactamase in the intervention area compared with the control area (-13.5% vs. -2.6%), and a lesser decrease for penicillins susceptible to beta-lactamase (-4.7% vs. -12.3%).

Overall, there was a 4.3% (95% CI, -7.1% to -1.5%) reduction in antibiotic prescribing in the intervention area compared with the control area.

The reduction in cost for prescribing antibiotics compared with the same period in the preceding year ranged approximately from $270,000 to $548,000.

However, Giulio and colleagues said the reduction in the prescribing of antibiotics was not related to changes in the knowledge or attitudes of the targeted population. Instead, reduced prescribing was "mediated by doctors' endorsement of the campaign goals or by an 'awareness of the campaign,' rather than by a decrease in pressure from patients to get antibiotics or to patients' participation in a 'wait and see' decision."

The researchers concluded that the "availability of information, put in a proper context, could be a positive element in itself, creating a favorable climate for potentially relevant societal changes or changes in decision making even if that information does not influence the population directly targeted."

Disclosure: Formoso reports no relevant financial disclosures. The study was publicly funded through a grant from the Italian Medicines Agency.