Intervention Study to Improve Antibiotic Prescription in Outpatient Care

Study Overview
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Brief Summary
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Antimicrobial resistance has become a world-wide problem and antibiotic consumption is a major driving force for the development of resistance. Thus optimization of antibiotic prescription and reduction of unnecessary antimicrobial treatment are essential in the prevention and reduction of antimicrobial resistance rates. The goal of this study is the improvement of antibiotic prescription in outpatient care. The study will take place within a Swiss-wide sentinel surveillance network of physicians. The participating physicians will be randomised in a control and intervention group. The intervention group will receive therapeutic guidelines for the treatment of upper and lower respiratory tract infections and lower urinary tract infection as well as regular feed-backs on the prescription pattern of the sentinel physicians during the past months. Sentinel physicians will collect information about each antibiotic prescription, its indication and characteristics of the patient. Our hypothesis is that the prescription pattern in the intervention group will be optimised and unnecessary antibiotic therapy will be reduced compared to the control group.

Detailed Description
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Background Antimicrobial resistance has become a world-wide problem and antibiotic consumption is a major driving force for the development of resistance. Thus optimization of antibiotic prescription and reduction of unnecessary antimicrobial treatment are essential in the prevention and reduction of antimicrobial resistance rates. The goal of this study is the qualitative and quantitative improvement of antibiotic prescription in outpatient care. The study will take place within a Swiss-wide sentinel surveillance network consisting of general practitioners, pediatricians and physicians specialized in internal medicine. The participating physicians will be randomised in a control and intervention group. The intervention group will receive therapeutic guidelines for the treatment of upper and lower respiratory tract infections and lower urinary tract infections. Furthermore, regular feed-backs on the prescription pattern of the sentinel physicians in the last months will be provided. Information about each antibiotic prescription, its indication and the characteristics of the patients will be collected by the sentinel physicians. The standardized reporting of antibiotic prescription by sentinel physicians has been carried out in Switzerland since 2006. Our hypothesis is that the intervention will affect the antibiotic prescription pattern and that the investigators will observe an optimization of antibiotic prescription and a decrease in the number of antibiotic prescriptions. Objective Primary goals: Increase of the percentage of penicillin prescriptions for upper and lower respiratory tract infections Increase of the percentage of TMP/SMX prescriptions for lower urinary tract infections in adults Secondary goal: Decrease of the percentage of quinolone prescriptions for COPD exacerbations in adults Decrease of the number of antibiotic prescriptions for sinusitis and other upper respiratory tract infections Methods Prospective cluster-randomised intervention study. The intervention is the mailing of treatment guidelines for upper and lower respiratory tract infections and lower urinary tract infections as well as regular feed-backs on the antibiotic prescription patterns of the sentinel physicians during the past months.

Official Title
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Improvement of Antibiotic Prescription in Outpatient Care: a Cluster-randomised Intervention Study Using a Sentinel Surveillance Network of Physicians

Conditions
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Respiratory Tract Infections, Urinary Tract Infections

Intervention / Treatment
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* Other: Mailing of antibiotic therapy guidelines to the sentinel physicians


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with respiratory tract infections or urinary tract infections Exclusion Criteria Patients with chronic disease requiring regular antibiotic treatment
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual information policy<br>No specific intervention | |
| Other: Antibiotic therapy guidelines<br> | Other: Mailing of antibiotic therapy guidelines to the sentinel physicians<br>* Mailing of antibiotic therapy guidelines to the sentinel physicians and regular feedback on antibiotic prescription<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of prescriptions of penicillin for respiratory tract infections |  | Two years | 
| Percentage of prescriptions of TMP/SMX for lower urinary tract infections in adults |  | Two years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of prescriptions of quinolone for COPD exacerbations in adults |  | Two years | 
| Percentage of antibiotic prescriptions for the indications sinusitis and other upper respiratory tract infections |  | Two years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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antimicrobial resistance, antibiotic prescription, primary health care, cluster-randomized trial