Strategies to help doctors change the way they prescribe antibiotics for patients with acute respiratory infections

New
Authors: 
Tonkin-Crine SKG, Tan P, van Hecke O, Wang K, Roberts NW, McCullough A, Hansen M, Butler CC, Del Mar CB

Overview question

This overview aimed to summarise all evidence from systematic reviews on strategies directed at doctors to reduce the antibiotic prescriptions they give to patients with acute respiratory infections (ear, nose, throat or chest infections).

Background

It is important that antibiotics are used for illnesses where they can make a difference to patients’ symptoms and recovery and that they are available for those infections that are serious and can lead to disability or death. Antibiotics may make very little or no difference for patients who have ear, nose, throat, or chest infections that are caused by a virus (e.g. a cold, flu, or sore throat). Doctors can prescribe antibiotics too readily for patients with these symptoms. Strategies to change doctors’ antibiotic prescribing habits have been developed to reduce the number of antibiotics given to patients with these symptoms. Several types of strategies exist, and it is important to bring together all the information on how these work.

Study characteristics

We identified five Cochrane Reviews and three non-Cochrane reviews. The reviews varied in how many trials they included and the number of participants within trials. The quality of both the reviews and trials varied.

Key results

We found moderate-quality evidence that three types of strategies probably help to reduce antibiotic prescribing in primary care. Strategies that encourage the use of shared decision making between doctors and their patients, C-reactive protein tests, and procalcitonin-guided management (both tests that measure the amount of proteins in the blood, which may be raised in the case of infection) all probably reduce antibiotic prescribing in general practice. Procalcitonin-guided management also probably reduces antibiotic prescribing in emergency departments. These strategies seem to change antibiotic prescribing whilst keeping patients happy with their consultation and ensuring that they did not need to return to their doctor for the same illness. There was no information about the cost of these strategies, so it was difficult to weigh up the benefits and costs.

The quality of the evidence for strategies that aim to educate doctors about antibiotic prescribing, that provide decision aids for doctors to help them change their prescribing, and for the use of rapid viral diagnostics in emergency departments was either low or very low, meaning that we were unable to draw firm conclusions about the effects of these strategies.

In conclusion, we determined that some strategies aimed at doctors can probably help to reduce antibiotic prescribing in primary care. Further studies are needed for other types of strategies where there is less information about whether they can change prescribing.

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