Online Support Reduces Unnecessary Antibiotic Prescriptions

A new study shows that electronically delivered prescribing feedback and online decision support reduce unnecessary antibiotic prescriptions for respiratory illness.

Researchers at the University of Southampton (US; United Kingdom), the University of Bristol (United Kingdom), King’s College London (KCL; United Kingdom), and other institutions conducted a study to evaluate the effectiveness and safety of electronically delivered prescribing feedback and decision support interventions to doctors in general practice (GP) at reducing antibiotic prescribing for self-limiting respiratory tract infections.

The randomized controlled trial involved patients in79 GPs who were randomized to antimicrobial stewardship (AMS) intervention or usual care between November 2015 and August 2016, with final follow-up in August 2017. AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing. The main outcome measure was the rate of antibiotic prescriptions for respiratory tract infections, as derived from electronic health records (EHRs).

The results showed that antibiotic prescribing was reduced by 12% overall, indicating one antibiotic prescription avoided for every 62 patients. There was no evidence that serious bacterial complications, including pneumonia or scarlet fever, were increased as the result of the AWS intervention. The results also showed that despite AWS, doctors did not reduce antibiotic prescribing to children (under 15 years) or to older adults (85 years and older). The study was published on February 13, 2019, in BMJ.

“Misuse of antibiotics is putting us all at risk. Taking antibiotics when they are not needed is leading to the emergence of resistant infections that can be very difficult to treat,” said lead author Professor Martin Gulliford, MD, PhD, of the department of public health at KCL. “This trial showed that providing GPs with information about their use of antibiotics for respiratory illnesses led to a reduction in antibiotic use. If this approach is scaled up nationally, it could contribute to reducing the emergence of antibiotic resistance.”

Approximately two million people suffer antibiotic-resistant infections annually, which result in over 23,000 deaths. Major drivers of resistance include self-medication, noncompliance, misinformation, and advertising pressures, combined with ignorance, lack of education, and lack of access to healthcare. The problem is complicated by both economic and social barriers to the rational use of drugs, for example in hospitals.

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University of Southampton
University of Bristol
King’s College London