Feasibility and effectiveness of a low cost campaign on antibiotic prescribing in Italy: community level, controlled, non-randomised trial

Abstract

Objectives To test the hypothesis that a multifaceted, local public campaign could be feasible and influence antibiotic prescribing for outpatients.Design Community level, controlled, non-randomised trial.Setting Provinces of Modena and Parma in Emilia-Romagna, northern Italy, November 2011 to February 2012.Population 1 150 000 residents of Modena and Parma (intervention group) and 3 250 000 residents in provinces in the same region but where no campaign had been implemented (control group).Interventions Campaign materials (mainly posters, brochures, and advertisements on local media, plus a newsletter on local antibiotic resistance targeted at doctors and pharmacists). General practitioners and paediatricians in the intervention area participated in designing the campaign messages.Main outcomes measures Primary outcome was the average change in prescribing rates of antibiotics for outpatient in five months, measured as defined daily doses per 1000 inhabitants/day, using health districts as the unit of analysis.Results Antibiotic prescribing was reduced in the intervention area compared with control area (−4.3%, 95% confidence interval −7.1% to −1.5%). This result was robust to “sensitivity analysis” modifying the baseline period from two months (main analysis) to one month. A higher decrease was observed for penicillins resistant to β lactamase and a lower decrease for penicillins susceptible to β lactamase, consistent with the content of the newsletter on antibiotic resistance directed at health professionals. The decrease in expenditure on antibiotics was not statistically significant in a district level analysis with a two month baseline period (main analysis), but was statistically significant in sensitivity analyses using either a one month baseline period or a more powered doctor level analysis. Knowledge and attitudes of the target population about the correct use of antibiotics did not differ between the intervention and control areas.Conclusions A local low cost information campaign targeted at citizens, combined with a newsletter on local antibiotic resistance targeted at doctors and pharmacists, was associated with significantly decreased total rates of antibiotic prescribing but did not affect the population’s knowledge and attitudes about antibiotic resistance. Trial registration ClinicalTrials.gov NCT01604096.

General practitioners’ knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications

“…This programme successfully reduced the unnecessary use of antibiotics by 26.5% over 5 years from 2002-2007 (12). In Italy, a community-based educational intervention to improve antibiotic prescribing in the outpatient setting including posters, brochures, and advertisements in the local media targeting the community, and a newsletter on antibiotic resistance targeting pharmacists and physicians, significantly improved antibiotic prescribing (63). A recent study from India suggested several interventions for improving antibiotic prescribing.…”

“…The findings from this survey suggest it is important that the authorities and heads of the medical profession in Malaysia take steps to reduce inappropriate antibiotic prescribing building on examples in the literature (12,51,(54)(55)(56)63). For example, in France, the government launched a nationwide campaign in 2002 to reduce the antibiotic use in the community.…”

What Drives Variation in Antibiotic Prescribing for Acute Respiratory Infections?

“…This could be accomplished through low-cost interventions such a notification informing patients that for the majority of acute respiratory infections, the clinician does not prescribe antibiotics, a poster in the waiting room stating that the practice is committed to prescribing antibiotics only when appropriate, 22 or sending patients literature on antibiotic overuse prior to the visit or providing it in the waiting room. 23 Another set of interventions -which have resulted in only modest reductions in antibiotic prescribing rates-to a more active review when clinicians prescribe antibiotics inappropriately.…”

Prescribing patterns for upper respiratory tract infections: a prescription-review of primary care practice in Kedah, Malaysia, and the implications

“…These multifaceted campaigns and interventions have resulted in a significant reduction in antibiotic use as well as expenditures across those countries [22][23][24][25][26][27][28][29]. However, antibiotic consumption continues to be a concern among Asia Pacific countries, where reported rates of antibiotic prescription in ambulatory care centres vary from 11·6% to as high as 82% [30][31][32][33][34][35].…”