Prescriber commitment posters to increase prudent antibiotic prescribing in English general practice: a cluster randomized controlled trial

Journal article

Unnecessary antibiotic prescribing contributes to Antimicrobial Resistance posing a major public health risk. Estimates suggest as many as half of antibiotics prescribed for respiratory infections may be unnecessary. We conducted a three-armed unblinded cluster randomized controlled trial (ISRCTN trial registry 83322985). Interventions were a commitment poster (CP) advocating safe antibiotic prescribing or a CP plus an antimicrobial stewardship message (AM) on telephone appointment booking lines, tested against a usual care control group. The primary outcome measure was antibiotic item dispensing rates per 1000 population adjusted for practice demographics. The outcome measures for post-hoc analysis were dispensing rates of antibiotics usually prescribed for upper respiratory tract infections and broad spectrum antibiotics. In total, 196 practice units were randomized to usual care (n = 60), CP (n = 66), and CP&AM (n = 70). There was no effect on the overall dispensing rates for either interventions compared to usual care (CP 5.673, 95%CI −9.768 to 1.113, p = 0.458; CP&AM, −12.575, 95%CI −30.726 to 5.576, p = 0.167). Secondary analysis, which included pooling the data into one model, showed a significant effect of the AM (−18.444, 95%CI −32.596 to −4.292, p = 0.012). Fewer penicillins and macrolides were prescribed in the CP&AM intervention compared to usual care (−12.996, 95% CI −34.585 to −4.913, p = 0.018). Commitment posters did not reduce antibiotic prescribing. An automated patient antimicrobial stewardship message showed effects and requires further testing.

Authors: Sallis, A; Bondaronek, P; Sanders, J; Yu, L; Harris, V

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: MDPI
• Journal: Antibiotics
• Volume: 9
• Issue: 8
• Article number: 490
• Publication date: 2020-08-07
• Acceptance date: 2020-07-01
• DOI: 10.3390/antibiotics9080490
• EISSN: 2079-6382
• Keywords: primary care; antibiotic prescribing; FFR; antimicrobial stewardship; antibiotic resistance; commitment posters