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Background <p>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.</p> Methods Design <p>Prospective, cluster-randomized trial.</p> Intervention <p>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).</p> Setting <p>Four Primary healthcare centers in Qatar with study period from August 2023 to October 2024.</p> Participants <p>Individuals with a diagnosis of URTI who were prescribed antibiotics.</p> Main outcome(s) <p>Reduction in inappropriate antibiotic prescriptions for URTIs in the intervention vs. control group during the 11-month follow-up period.</p> Results <p>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%; <i>p</i> &lt; <i>0.001</i>) between the two groups. The relative drop in inappropriate antibiotic prescriptions before and after the interventions was 16.3% (42.4% vs 35.5%; <i>p</i> &lt; <i>0.001</i>) at intervention sites (<i>p</i> &lt; <i>0.001</i>) compared with 2.2% (45.9% to 44.9%; <i>p</i> = <i>0.4</i>) at control sites. Senior-most physicians and younger population (19–40&#xa0;years old) were more likely to prescribe or receive inappropriate antibiotic prescription.</p> Conclusion <p>A multi-component intervention can significantly reduce inappropriate antibiotic prescriptions for URTIs in the outpatient setting.</p> ClinicalTrials.gov ID <p>NCT06135376, Registration Date: November 9, 2023.</p>

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A prospective cluster randomized trial of an interventions bundle to reduce inappropriate antibiotic use for upper respiratory tract infections in the outpatient setting

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月1日

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  • Adeel A. Butt,
  • Sherin Shams,
  • Atika Jabeen,
  • Asma Ali Al-Nuaimi,
  • Jeyaram Illiayaraja Krishnan,
  • Aimon B. Malik,
  • Samah Saleem,
  • Maryam Hassan Abdulaziz,
  • Naheel Ismail Seyam,
  • Kamran Aziz,
  • Dalia Kandil,
  • Anil G. Thomas,
  • Hanaa Nafady-Hego,
  • Muzna I. Lone,
  • Jameela Al Ajmi,
  • Zain A. Bhutta,
  • Noora AlSulaiti,
  • Wael E. Said Hussein,
  • Sandy Semaan,
  • Samya Ahmad Al-Abdulla,
  • Mohamed Ghaith Al-Kuwari,
  • Abdul-Badi Abou-Samra

摘要

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 was 16.3% (42.4% vs 35.5%; p < 0.001) at intervention sites (p < 0.001) compared with 2.2% (45.9% to 44.9%; p = 0.4) at control sites. Senior-most physicians and younger population (19–40 years old) were more likely to prescribe or receive inappropriate antibiotic prescription.

Conclusion

A multi-component intervention can significantly reduce inappropriate antibiotic prescriptions for URTIs in the outpatient setting.

ClinicalTrials.gov ID

NCT06135376, Registration Date: November 9, 2023.