Abstract
High antibiotic prescribing and antimicrobial resistance in patients attending primary care have been reported in South America. Very few interventions targeting general practitioners (GPs) to decrease inappropriate antibiotic prescribing have been investigated in this region. This study assessed the effectiveness of online feedback on reducing antibiotic prescribing in patients with suspected respiratory tract infections (RTIs) attending primary care. The aim was to reduce antibiotic prescribing in patients with acute bronchitis and acute otitis media. Both are RTIs for which antibiotics have a very limited effect. A cluster randomized two-arm control trial was implemented. Healthcare centres from Bolivia, Argentina, Paraguay and Uruguay participating in the quality improvement program HAPPY AUDIT were randomly allocated to either intervention or control group. During ten consecutive weeks, GPs in the intervention group received evidence-based online feedback on the management of suspected RTIs. In patients with acute bronchitis, the intervention reduced the antibiotic prescribing rate from 71.6% to 56% (control group from 61.2% to 52%). In patients with acute otitis media, the intervention reduced the antibiotic prescribing from 94.8% to 86.2% (no change in the control group). In all RTIs, the intervention reduced antibiotic prescribing rate from 37.4% to 28.1% (control group from 29% to 27.2%). Online evidence-based feedback is effective for reducing antibiotic prescribing in patients with RTIs attending primary care in South America.
Highlights
Inappropriate use of antibiotics generates Antimicrobial Resistance (AMR), which represents a serious threat for societal development due to its health and economic impact [1,2].Antimicrobial resistance (AMR) is an increasing global problem
In a previous study [6], we found that general practitioners (GPs) from Argentina prescribed antibiotics on average to 41% of the patients consulting with respiratory tract symptoms
110 Antibiotics health care were randomized to intervention or control group
Summary
Inappropriate use of antibiotics generates Antimicrobial Resistance (AMR), which represents a serious threat for societal development due to its health and economic impact [1,2].Antimicrobial resistance (AMR) is an increasing global problem. Inappropriate use of antibiotics generates Antimicrobial Resistance (AMR), which represents a serious threat for societal development due to its health and economic impact [1,2]. Studies have found a high prevalence of AMR in several countries in Latin America, for pathogens involved in community acquired respiratory tract infections (RTIs) [3,4,5] such as Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis. This study analyzed consumption of antibiotics between 1997 and 2007 in eight Latin American countries. There was an increase in consumption of antibiotics and great variation across countries. In Uruguay, during this period, the consumption of antibiotics increased from 5.43 Defined Daily Dosis per 1000 inhabitants per day (DID) in 1997 to
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