Systematic Reviews
For Healthcare Professionals
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Below is a collection of systematic reviews that have examined the most effective interventions to improve antibiotic prescribing for outpatients.
| Reference | Interventions and Outcomes | Methods, Participants, and Settings | Results | Conclusions |
|---|---|---|---|---|
| Arnold SR, et al. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005. 4:CD003539. | Interventions
• Physician educational materials • Audit and feedback • Educational meetings • Educational outreach visits • Financial and healthcare system changes • Physician reminders • Patient-based interventions • Multi-faceted interventions Outcomes • Improve selection, dose and duration of antibiotics prescribed • Reduce incidence of pathogens with antimicrobial resistance |
Methods
• Systematic review Participants • Healthcare consumers or primary care providers Setting • Primary care clinics and ambulatory care clinics |
• 39 studies
• Only small changes observed for single interventions using printed educational materials or audit and feedback. • Active educational interventions are more effective than nonactive interventions. • Delayed prescriptions effectively reduced antibiotic use by patients without negatively affecting patient outcomes. • Multifaceted interventions were more successful in decreasing inappropriate antibiotic prescribing. |
• Multifaceted interventions are most effective.
• No single intervention is recommended for all settings. |
| Drekonja DM et al. Antimicrobial stewardship in outpatient settings: a systematic review. Infect Control Hosp Epidemiol 2015. Feb;36(2):142–52.
|
Interventions
• Provider and or patient education • Provider feedback • Delayed prescribing • Communication skills training • Guidelines • Restriction Policies • Computerized clinical decision support • Financial incentives • Rapid diagnostics • Costs reporting Outcomes • Prescribing outcomes • Patient outcomes • Microbial outcomes • Costs
|
Methods
• Systematic review Participants • Primarily healthcare consumers and primary care providers Setting • Primary care clinics and ambulatory care clinics
|
• 50 studies
• Stewardship programs using communication skills training and laboratory testing can lower antibiotic use. • Several stewardship interventions can effectively improve antibiotic prescribing. • Patient outcomes were not often reported, but did not appear to worsen due to intervention. |
• Outpatient antibiotic stewardship programs can improve antibiotic prescribing without negatively affecting patient outcomes.
• Sustainability and scalability of specific interventions is less clear. |
| McDonagh M, et al. Improving Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections. AHRQ Comparative Effectiveness Reviews 2016. No. 163.
|
Interventions
• Education • Communication • Clinical • System-level • Multifaceted interventions Outcomes • Improvement of appropriate antibiotic prescribing • Reduction in antibiotic resistance • Reduction in overall antibiotic prescribing for acute respiratory tract infections (RTIs) • Increases in adverse drug events • Increases in patient dissatisfaction |
Methods
• Systematic review Participants • Healthcare consumers (both adults and children) with acute RTIs • Primary care providers Setting • Primary care clinics and ambulatory care clinics
|
• 133 studies
• Four interventions showed evidence of improving antibiotic prescribing with without worsening patient outcomes due to reductions in antibiotic prescribing: o Clinic-based parent education (21% reduction). o Public patient education campaigns combined with clinician education (7% prescribing reduction). o Procalcitonin for adults (12% to 72% prescribing reduction). o Electronic decision support systems (improved antibiotic selection and 5% to 9% reduction in prescribing). o Public parent education campaigns reduce overall prescribing without increasing followup visits. |
• Several interventions safely reduced antibiotic prescribing or improved appropriate antibiotic prescribing without adversely affecting patient outcomes.
• These include education for patients, parents, and clinicians, procalcitonin testing in adults, and electronic clinician decision support.
|
| Ranji SR, et al. Interventions to reduce unnecessary antibiotic prescribing: A systematic review and quantitative analysis. Med Care 2008. 46(8):847–62. | Interventions
• Clinician education • Patient education • Audit and feedback • Clinician reminders Outcomes • Reduction in proportion of patients receiving antibiotics |
Methods
• Systematic review and quantitative analysis Participants • Healthcare consumers (both adults and children) with acute outpatient infections • Primary care providers Setting • Primary care clinics and ambulatory care clinics |
• 43 studies
• Most studies examined antibiotic prescribing for acute respiratory infections. • The quantitative analysis (n = 30 studies) found a median reduction of 9.7% in the percent of patients receiving antibiotics • No single intervention was clearly superior. • Active clinician education strategies had a nonsignificant trend toward better efficacy compared with passive education strategies. |
• Some interventions are effective at reducing antibiotic use in outpatient settings.
• Active clinician education strategies appear to work better than passive education strategies. • Targeting antibiotic prescribing for all ARIs, versus single diagnoses, may lead to larger reductions in antibiotic use. |
| van der Velden AW, et al. Effectiveness of physician-targeted interventions to improve antibiotic use for respiratory tract infections. Br J of Gen Pract 2012. 62(605):e801–7.
|
Interventions
• Educational materials (patients, clinicians, and the general public) • Educational meetings • Consensus procedure • Local opinion leaders • Near-patient testing • Audit and feedback • Financial incentives • Communications skills training Outcomes • Difference of differences for interventions with a before and after measurement with a control group • Differences for interventions with a before and after measurement without a control group • Difference in after measurement for interventions with a control group but without a before measurement |
Methods
• Systematic review Participants • Healthcare consumers (both adults and children) with acute outpatient infections • Primary care providers Setting • Primary care clinics in high income countries
|
• 58 studies
• About 60% of studies contained interventions that led to significant improvements in antibiotic prescribing. • Interventions targeting decreases in overall antibiotic prescription were more often effective than interventions targeting improvements in antibiotic selection. • Antibiotic prescriptions were reduced on average by 11.6%. First-line antibiotic prescription increased on average by 9.6%. • Combination interventions targeting clinicians were more often effective compared with single interventions. • Interventions containing patient-directed materials demonstrated no added value. • Interventions with the largest effect sizes included communication skills training and point-of-care testing. |
• Clinician education, including communication skills training, is important to optimize antibiotic use.
• Combination interventions appear to be more effective than individual interventions.
|
- Page last reviewed: April 17, 2015
- Page last updated: May 12, 2017
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