Effect of Intervention Promoting a Reduction in Antibiotic Prescribing by Improvement of Diagnostic Procedures: a Prospective, Before and After Study in General Practice

Overview

Journal Eur J Clin Pharmacol

Specialty Pharmacology

Date 2006 Sep 13

PMID 16967300

Citations 12

Authors

Lars Bjerrum

Josep M Cots

Carl Llor

Nuria Molist

Anders Munck

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate if an intervention aimed at improving the quality of the diagnostic procedures in Spanish general practice could lower antibiotic prescribing in patients with respiratory tract infections (RTIs).

Methods: GPs in the intervention group (n=17) registered all patients with RTIs during a 3-week period before and after the intervention. The intervention was aimed at reducing prescribing of inappropriate antibiotics for RTIs by improving the diagnostic procedures and thereby helping the GPs to distinguish between bacterial and viral infections. It consisted of courses in management of RTI according to local clinical guidelines, and included implementation of two rapid diagnostic tests (StrepA and CRP measurement). Diagnoses and prescribing of antibiotics were assessed before and after the intervention, and compared to a control group not exposed to intervention (35 GPs).

Results: The intervention led to a significant reduction in antibiotic prescribing. Before the intervention 36% (29%-44%) of consultations were followed by antibiotic prescribing, after the intervention 24% (20%-29%). Antibiotic prescribing in the control group not exposed to intervention was 32% (27%-38%). The reduction was most pronounced in patients with sinusitis and lower RTIs.

Conclusion: Quality improvement of diagnostic procedures may lead to a reduction of antibiotic prescribing in primary health care in Spain.

Citing Articles

Effect of Combination of Point-of-Care C-Reactive Protein Testing and General Practitioner Education and Long-Term Effect of Education on Reducing Antibiotic Prescribing for Children Presenting with Acute Infections in General Practice in Latvia: A....

Likopa Z, kivite-Urtane A, Strele I, Pavare J Antibiotics (Basel). 2024; 13(9).

PMID: 39335040 PMC: 11428635. DOI: 10.3390/antibiotics13090867.

Educational Interventions to Reduce Prescription and Dispensing of Antibiotics in Primary Care: A Systematic Review of Economic Impact.

Rocha V, Estrela M, Neto V, Roque F, Figueiras A, Herdeiro M Antibiotics (Basel). 2022; 11(9).

PMID: 36139965 PMC: 9495011. DOI: 10.3390/antibiotics11091186.

The comparative interrupted time series design for assessment of diagnostic impact: methodological considerations and an example using point-of-care C-reactive protein testing.

Fanshawe T, Turner P, Gillespie M, Hayward G Diagn Progn Res. 2022; 6(1):3.

PMID: 35232491 PMC: 8888027. DOI: 10.1186/s41512-022-00118-w.

Changes in antibiotic prescription following an education strategy for acute respiratory infections.

Delsors E, Monso F, Lopez-Roman F, Menarguez-Puche J, Gonzalez-Barbera M, Hukelova H NPJ Prim Care Respir Med. 2021; 31(1):34.

PMID: 34083534 PMC: 8175562. DOI: 10.1038/s41533-021-00247-7.

Reduction of antibiotic prescriptions for acute respiratory tract infections in primary care: a systematic review.

Kochling A, Loffler C, Reinsch S, Hornung A, Bohmer F, Altiner A Implement Sci. 2018; 13(1):47.

PMID: 29554972 PMC: 5859410. DOI: 10.1186/s13012-018-0732-y.

References

Melbye H, Aaraas I, Fleten N, Kolstrup N, Mikalsen J . [The value of C-reactive protein testing in suspected lower respiratory tract infections. A study from general practice on the effect of a rapid test on antibiotic research and course of the disease in adults]. Tidsskr Nor Laegeforen. 1995; 115(13):1610-5. View

Hopstaken R, Muris J, Knottnerus J, Kester A, Rinkens P, Dinant G . Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection. Br J Gen Pract. 2003; 53(490):358-64. PMC: 1314594. View

Picazo J, Perez-Cecilia E, Herreras A . [Respiratory infections outside the hospital. DIRA study]. Enferm Infecc Microbiol Clin. 2003; 21(8):410-6. DOI: 10.1016/s0213-005x(03)72978-4. View

Diederichsen H, Skamling M, Diederichsen A, Grinsted P, Antonsen S, PETERSEN P . Randomised controlled trial of CRP rapid test as a guide to treatment of respiratory infections in general practice. Scand J Prim Health Care. 2000; 18(1):39-43. DOI: 10.1080/02813430050202541. View

Miravitlles M, Mayordomo C, Artes M, Nicolau F, Segu J . Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. EOLO Group. Estudio Observacional de la Limitación Obstructiva al Flujo aEreo. Respir Med. 1999; 93(3):173-9. DOI: 10.1016/s0954-6111(99)90004-5. View

Lindbaek M, Hoiby E, Lermark G, Steinsholt I, Hjortdahl P . Which is the best method to trace group A streptococci in sore throat patients: culture or GAS antigen test?. Scand J Prim Health Care. 2005; 22(4):233-8. DOI: 10.1080/02813430410006675. View

Bremon A, Ruiz-Tovar M, Gorricho B, de Torres P, Rodriguez R . Non-hospital consumption of antibiotics in Spain: 1987-1997. J Antimicrob Chemother. 2000; 45(3):395-400. DOI: 10.1093/jac/45.3.395. View

Pradier C, Dunais B, Carsenti-Etesse H, Dellamonica P . Pneumococcal resistance patterns in Europe. Eur J Clin Microbiol Infect Dis. 1997; 16(9):644-7. DOI: 10.1007/BF01708553. View

HOWIE J . Clinical judgement and antibiotic use in general practice. Br Med J. 1976; 2(6043):1061-4. PMC: 1689105. DOI: 10.1136/bmj.2.6043.1061. View

10.

Ochoa C, Inglada L, Eiros J, Solis G, Vallano A, Guerra L . Appropriateness of antibiotic prescriptions in community-acquired acute pediatric respiratory infections in Spanish emergency rooms. Pediatr Infect Dis J. 2001; 20(8):751-8. DOI: 10.1097/00006454-200108000-00007. View

11.

Contopoulos-Ioannidis D, Koliofoti I, Koutroumpa I, Giannakakis I, Ioannidis J . Pathways for inappropriate dispensing of antibiotics for rhinosinusitis: a randomized trial. Clin Infect Dis. 2001; 33(1):76-82. DOI: 10.1086/320888. View

12.

Bjerrum L, Boada A, Cots J, Llor C, Fores Garcia D, Gahrn-Hansen B . Respiratory tract infections in general practice: considerable differences in prescribing habits between general practitioners in Denmark and Spain. Eur J Clin Pharmacol. 2003; 60(1):23-8. DOI: 10.1007/s00228-003-0706-z. View

13.

van der Meer V, Neven A, van den Broek P, Assendelft W . Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ. 2005; 331(7507):26. PMC: 558535. DOI: 10.1136/bmj.38483.478183.EB. View

14.

Bjerrum L, Gahrn-Hansen B, Munck A . C-reactive protein measurement in general practice may lead to lower antibiotic prescribing for sinusitis. Br J Gen Pract. 2004; 54(506):659-62. PMC: 1326065. View

15.

Llor C, Bjerrum L . Background for different use of antibiotics in different countries. Clin Infect Dis. 2005; 40(2):333. DOI: 10.1086/427035. View

16.

. Report of the ASM task force on antibiotic resistance. Antimicrob Agents Chemother. 1995; Suppl:1-23. View

17.

Lervy B, Wareham K, Cheung W . Practice characteristics associated with audit activity: a medical audit advisory group survey. Br J Gen Pract. 1994; 44(384):311-4. PMC: 1238929. View

18.

Llor C, Bayona C . Spanish primary healthcare physicians' knowledge of resistance of respiratory germs and antimicrobial treatment in acute bronchitis. Eur J Gen Pract. 2004; 10(3):88-92. DOI: 10.3109/13814780409044541. View

19.

Bronzwaer S, Cars O, Buchholz U, Molstad S, Goettsch W, Veldhuijzen I . A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis. 2002; 8(3):278-82. PMC: 2732471. DOI: 10.3201/eid0803.010192. View