Abstract
BackgroundUrinary tract infections (UTIs) are a common cause of prescribing antibiotics in family medicine. In Germany, about 40% of UTI-related prescriptions are second-line antibiotics, which contributes to emerging resistance rates. To achieve a change in the prescribing behaviour among family physicians (FPs), this trial aims to implement the guideline recommendations in German family medicine.Methods/designIn a randomized controlled trial, a multimodal intervention will be developed and tested in family practices in four regions across Germany. The intervention will consist of three elements: information on guideline recommendations, information on regional resistance and feedback of prescribing behaviour for FPs on a quarterly basis. The effect of the intervention will be compared to usual practice. The primary endpoint is the absolute difference in the mean of prescribing rates of second-line antibiotics among the intervention and the control group after 12 months. To detect a 10% absolute difference in the prescribing rate after one year, with a significance level of 5% and a power of 86%, a sample size of 57 practices per group will be needed. Assuming a dropout rate of 10%, an overall number of 128 practices will be required. The accompanying process evaluation will provide information on feasibility and acceptance of the intervention.DiscussionIf proven effective and feasible, the components of the intervention can improve adherence to antibiotic prescribing guidelines and contribute to antimicrobial stewardship in ambulatory care. Trial registration DRKS, DRKS00020389, Registered 30 January 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020389.
Highlights
Urinary tract infections (UTIs) are a common cause of prescribing antibiotics in family medicine
Methods/design REDuction of Antibiotic RESistance (REDARES) is a randomized controlled trial (RCT) based on aggregated patient data with family practices being the unit of randomization
Intervention We developed a multimodal intervention consisting of (a) information on guideline recommendations and on regional resistance data and (b) feedback of prescribing behaviour for family physicians (FPs) aiming to translate knowledge from practice guidelines and research into practice and to facilitate implementation of guideline adherent treatment [21]
Summary
We expect that the multimodal intervention that includes information on guideline recommendations, on regional resistance data and feedback of prescribing behaviour for FPs will enhance guideline adherence in this group. A limitation of the study might be the manually extracted retrospective outcome data from the electronic patient records, which will rely on the documentation quality. Selection of research-interested practices is possible and the sample will probably not fully represent the usual practices. We are sure the protocol of the study will be of interest for physicians, epidemiologists and researchers, who struggle with the increase of antibiotic resistance due to inappropriate antibiotic prescriptions, as effective anti-infective agents are essential. If proven effective and feasible, the components of the intervention can improve adherence to antibiotic prescribing guidelines and contribute to antimicrobial stewardship in ambulatory care
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
