What Works (or Not) to Reduce Antibiotic Prescribing?

March 30, 2023

Written by Chris Thom

Spoon Feed
Providing quarterly antibiotic prescription audits alongside peer benchmarking did not reduce antibiotic rates in a large cohort of primary care physicians in Switzerland.

Why does this matter?
Excessive antibiotic prescriptions can lead to increased community antimicrobial resistance. Efforts to reduce the unnecessary usage of antibiotics are needed.

Antibiotics for me and for thee…..  
This was a RCT of primary care physicians in Switzerland. Physicians were randomized to receive a quarterly antibiotic prescribing audit with feedback and peer benchmarking versus no intervention over a 2 year period. The intervention group also received evidence-based guidelines on urinary tract infection and respiratory illnesses, as well as community antimicrobial resistance information. Physicians in the intervention group were not aware that their antibiotic prescription rates were being monitored in a trial setting.

3,426 physicians were randomized, with 1,713 being in the intervention group and 1,713 in the control group. Median annual antibiotic prescription rates per 100 visits in the year preceding the trail were nearly identical at 8.4 (IQR 6.3-11.5) in the intervention group and 8.4 (IQR 6.4-11.6) in the control group. For both cohorts of physicians, there was an overall 4.2% increase in the antibiotic prescription rate over the 2 year intervention (95%CI 3.9%-4.6%). In the second year of the intervention, the median antibiotic rate was 8.2 (IQR 6.1-11.4) in the intervention group and 8.4 (IQR 6.0-11.8) in the control group. There was a 0.1% (95%CI -1.2% to 1%) lower antibiotic prescribing rate per 100 consultations in the intervention group compared with the control group.

There was no statistically significant reduction in antibiotic prescribing rates amongst the cohort of primary care physicians that received regular feedback and audits of their antibiotic prescribing. The authors query whether this negative result was at least partially secondary to the already low rate of antibiotic consumption in Switzerland, as prior research has led to positive results.

Source
Effect of Antibiotic Prescription Audit and Feedback on Antibiotic Prescribing in Primary Care: A Randomized Clinical Trial. JAMA Intern Med. 2023 Feb 6. doi: 10.1001/jamainternmed.2022.6529. Online ahead of print.