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J Int Med Res. 2018 Aug;46(8):3337-3357. doi: 10.1177/0300060518782519. Epub 2018 Jul 1.

Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review.

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1 The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
6 Evidence-based Synthesis Program (ESP) Coordinating Center, VA Portland Health Care System, Portland, OR, USA.
2 Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA.
3 Department of Ophthalmology, Casey Eye Institute, Portland, OR, USA.
5 Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.
4 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.


Objective Antibiotic overuse contributes to antibiotic resistance and adverse consequences. Acute respiratory tract infections (RTIs) are the most common reason for antibiotic prescribing in primary care, but such infections often do not require antibiotics. We summarized and updated a previously performed systematic review of interventions to reduce inappropriate use of antibiotics for acute RTIs. Methods To update the review, we searched MEDLINE®, the Cochrane Library (until January 2018), and reference lists. Two reviewers selected the studies, extracted the study data, and assessed the quality and strength of evidence. Results Twenty-six interventions were evaluated in 95 mostly fair-quality studies. The following four interventions had moderate-strength evidence of improved/reduced antibiotic prescribing and low-strength evidence of no adverse consequences: parent education (21% reduction, no increase return visits), combined patient/clinician education (7% reduction, no change in complications/satisfaction), procalcitonin testing for adults with RTIs of the lower respiratory tract (12%-72% reduction, no increased adverse consequences), and electronic decision support systems (24%-47% improvement in appropriate prescribing, 5%-9% reduction, no increased complications). Conclusions The best evidence supports use of specific educational interventions, procalcitonin testing in adults, and electronic decision support to reduce inappropriate antibiotic prescribing for acute RTIs without causing adverse consequences.


Antibiotics; acute respiratory tract infections; adverse consequences; overuse; resistance; review

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