Public-targeted communication interventions to improve antibiotic use: a systematic review

Abstract

BackgroundAntimicrobial resistance poses a major threat to global health. Excessive use of antibiotics accelerates the process of resistance. Interventions to prevent the inappropriate use of antibiotics can be targeted at doctors, patients, and the public. The aim of this systematic review was to identify the components of successful communication interventions targeted at the general public to improve antibiotic use. MethodsThe databases Medline, Embase, CINAHL, Web of Science, and Cochrane Library were searched in July, 2015. The main search terms were related to the population (public, community, population, neighbourhood), intervention (communication, campaign, mass media), and outcomes (antibiotic, antimicrobial resistance). For each search term, synonyms and controlled vocabulary for respective databases were used. Titles, abstracts, and full-text references were screened for inclusion by one author with a random subset of 10% screened by a second author. No date restrictions were applied, and only articles in English were considered. Studies had to have a control group or be an interrupted time-series with interventions targeted at the general public. Outcomes had to measure change in antibiotic-related prescribing or consumption, knowledge, attitudes, or behaviour. Two reviewers assessed the quality of studies. Narrative synthesis was performed. Findings14 studies were included with an estimated 74–75 million participants. Most studies were conducted in the USA or Europe, used mass media, targeted both the general public and clinicians, and measured changes in antibiotic prescribing. There was quite strong (p<0·05 to ≥0·01) to very strong (p<0·001) evidence that interventions conducted on a national, community, and household level that targeted antibiotic prescribing for respiratory tract infections could achieve substantial reductions in antibiotic prescribing. The largest change in antibiotic prescribing was a 30% reduction. Insufficient studies were available to distinguish the separate components of interventions. No studies of high quality were identified. InterpretationCommunication interventions that target both the general public and clinicians should be considered as part of policy for reducing antibiotic prescribing in high-income countries. Future research should aim to be of greater quality, attempt to determine whether communication interventions targeted at the public could be effective without a clinician-directed element, and measure the sustainability of reductions in prescribing and potential adverse harms. FundingEC and RT are funded by the South West Public Health Training Programme. RK is funded by the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer).