Modifying Antibiotic Prescribing in Primary Care

Abstract

a result of inactive empirical antibiotic therapy as well as increasing economic costs for the community. Data on the association between the appropriateness of empirical antibiotic therapy and paitent outcomes is sparse for primary health care, compared with data from hospital settings, but anecdotal experience indicates that poor early antibiotic choice may be associated with progression of infection leading to hospitalization. In view of the above concerns, it appears reasonable that efforts be expended to improve the adequacy of antibiotic prescribing in the primary care setting. In this issue of Clinical Infectious Diseases, Rautakorpi et al. [7] describe a remarkable effort to improve antibiotic use in the Finnish primary health care setting. It has long been known that antibiotic prescribing is taken seriously in Scandinavia; indeed, almost one-third of all primary health care centers in Finland expressed a willingness to participate in this study. A multifaceted intervention was initiated over a 2-year period, primarily targeting physicians, although the authors hint at enhanced education for patients. One physician from each participating health care center spent 6.5 days in a “train the trainer” program. Their primary goal was to improve compliance among their colleagues with antibiotic prescribing guidelines for 6 common infections—otitis media, sinusitis, pharyngitis, acute bronchitis, bacterial skin infections, and urinary tract infections. Feedback on the study results, which acted as an important stimulus for ongoing adherence, was given to the physicians once a year. The intervention was successful on some, but not all, counts. There were significant improvements in compliance with first-line antibiotic treatment recommendations for sinusitis (from 35% to 51%; ), acute bronchitis (from 4% to P ! .001 9%; ), and urinary tract infec