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J Antimicrob Chemother. 2015 Feb;70(2):602-8. doi: 10.1093/jac/dku394. Epub 2014 Oct 17.

Improvement of antibiotic prescription in outpatient care: a cluster-randomized intervention study using a sentinel surveillance network of physicians.

Author information

1
Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
2
Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
3
Swiss Federal Office of Public Health, Bern, Switzerland.
4
Hospital Preventive Medicine Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
5
Division of Infectious Diseases, University Children's Hospital of Zurich, Zurich, Switzerland.
6
Institute for Infectious Diseases, University of Bern, Bern, Switzerland Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
7
Institute for Infectious Diseases, University of Bern, Bern, Switzerland Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland andreas.kronenberg@ifik.unibe.ch.

Abstract

OBJECTIVES:

To assess the effectiveness of implementing guidelines, coupled with individual feedback, on antibiotic prescribing behaviour of primary care physicians in Switzerland.

METHODS:

One hundred and forty general practices from a representative Swiss sentinel network of primary care physicians participated in this cluster-randomized prospective intervention study. The intervention consisted of providing guidelines on treatment of respiratory tract infections (RTIs) and uncomplicated lower urinary tract infections (UTIs), coupled with sustained, regular feedback on individual antibiotic prescription behaviour during 2 years. The main aims were: (i) to increase the percentage of prescriptions of penicillins for all RTIs treated with antibiotics; (ii) to increase the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics; (iii) to decrease the percentage of quinolone prescriptions for all cases of exacerbated COPD (eCOPD) treated with antibiotics; and (iv) to decrease the proportion of sinusitis and other upper RTIs treated with antibiotics. The study was registered at ClinicalTrials.gov (NCT01358916).

RESULTS:

While the percentage of antibiotics prescribed for sinusitis or other upper RTIs and the percentage of quinolones prescribed for eCOPD did not differ between the intervention group and the control group, there was a significant increase in the percentage of prescriptions of penicillins for all RTIs treated with antibiotics [57% versus 49%, OR=1.42 (95% CI 1.08-1.89), P=0.01] and in the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics [35% versus 19%, OR=2.16 (95% CI 1.19-3.91), P=0.01] in the intervention group.

CONCLUSIONS:

In our setting, implementing guidelines, coupled with sustained individual feedback, was not able to reduce the proportion of sinusitis and other upper RTIs treated with antibiotics, but increased the use of recommended antibiotics for RTIs and UTIs, as defined by the guidelines.

KEYWORDS:

ambulatory; antibiotic prescribing; guidelines

PMID:
25326088
DOI:
10.1093/jac/dku394
[Indexed for MEDLINE]
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