A prospective cluster randomized trial of an interventions bundle to reduce inappropriate antibiotic use for upper respiratory tract infections in the outpatient setting
Abstract
Background: Antibiotic overuse and increasing antimicrobial resistance are global public health threats. We determined the impact of a multicomponent intervention in reducing inappropriate antibiotic use for upper respiratory tract infections (URTIs) in the outpatient setting.
Methods: DESIGN: Prospective, cluster-randomized trial.
Intervention: Bundled 4-component intervention including extensive provider education, a decision support algorithm, option for deferred antibiotics prescription, and monthly feedback on prescription patterns, vs. a single randomly assigned intervention (decision support algorithm).
Setting: Four Primary healthcare centers in Qatar with study period from August 2023 to October 2024.
Participants: Individuals with a diagnosis of URTI who were prescribed antibiotics.
Main outcome(s): Reduction in inappropriate antibiotic prescriptions for URTIs in the intervention vs. control group during the 11-month follow-up period.
Results: We analyzed 20,062 episodes-of-care for URTIs with an antibiotic prescription (9,277 at control and 10,785 at intervention sites). In a mixed effects logistic regression model accounting for the clustering effect, the intervention was associated with a 29% reduction in odds of inappropriate antibiotics prescriptions ( [aOR] 0.71; 95% CI 0.66-0.77). The relative reduction was 20.9% (44.9% vs. 35.5%; p < 0.001) between the two groups. The relative drop in inappropriate antibiotic prescriptions before and after the interventions…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
Read the paper
Related studies
- Synthesis, In Vitro and In Silico Molecular Docking Studies of Novel Phthalimide–Pyrimidine Hybrid Analogues to Thalidomide as Potent Antitubercular Agents
- Exploring the inhibitory performance of expired moxifloxacin and norfloxacin on copper corrosion in saline environment
- Molecular investigation of antimicrobial peptides against Helicobacter pylori proteins using a peptide-protein docking approach
- Screening of novel narrow-spectrum benzofuroxan derivatives for the treatment of multidrug-resistant tuberculosis through in silico, in vitro, and in vivo approaches
- Synthesis, Characterization, Anticancer, Antioxidant, and In Silico Evaluation of Semicarbazides and Thiosemicarbazides
- Fast and accurate prediction of drug induced proarrhythmic risk with sex specific cardiac emulators
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.