Active education helps prevent antibiotic misuse

Reducing excessive or inappropriate antibiotic use is the best way to slow down the spread of antimicrobial resistance in bacterial infections. A report examining dozens of studies of quality-improvement (QI) interventions found that actively engaging the clinician in workshops or educational outreach on antibiotic treatment appears to be more effective than simply posting signs about correct/incorrect antibiotic use. However, most QI interventions are generally effective at reducing both inappropriate antibiotic selection and treatment.

The authors of the report, led by Sumant R. Ranji, M.D., searched the medical literature for studies of QI interventions in antibiotic prescribing; 54 studies met their inclusion criteria. Of these, 34 examined the clinician's decision to prescribe antibiotics (treatment decision), and 26 studies examined the decision as to antibiotic (selection decision). Six studies evaluated both decisions. Nearly all the studies were done in outpatient primary care clinics, and most examined prescribing practices for acute respiratory infections or urinary tract infections.

Overall, the study found that QI interventions to reduce prescribing of antibiotics for nonbacterial acute illnesses reduced prescription rates by an absolute value of 8.9%. QI interventions aimed at improving antibiotic selection resulted in a 10.6% improvement. Several QI interventions-educational outreach, workshops, and consensus-building sessions-can be implemented by pharmacists, said Scott R. Smith, Ph.D., R.Ph., AHRQ director of pharmaceutical outcomes research. And one-on-one educational sessions between a physician and a pharmacist can be effective where there is rapport between them, he noted. Audits of prescription practices can identify a physician or other clinician who is making poor prescribing choices.

The QI interventions appeared to have no effect on patient satisfaction with their medical care, Smith noted.

Controlling antibiotic resistance is the primary goal of QI interventions, but cost-saving is another. The study authors reported that for a 100,000-member health maintenance organization, a QI strategy targeting all acute respiratory infections for patients of all age groups would result in a saving of approximately 3,000 to 8,000 antibiotic prescriptions per year and between $90,000 and $400,000 annually in antibiotic costs.

The report (AHRQ Publication No. 04(06)-0051-4, January 2006) is available as a PDF file at http:// http://www.ahrq. gov/downloads/pub/evidence/pdf/medigap/medigap.pdf.

THE AUTHOR is a writer based in New York State.