Clinical trial NCT01358916: Intervention Study to Improve Antibiotic Prescription in Outpatient Care
Official title: Improvement of Antibiotic Prescription in Outpatient Care: a Cluster-randomised Intervention Study Using a Sentinel Surveillance Network of Physicians
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Respiratory Tract Infections
Urinary Tract Infections
Keywords: antimicrobial resistance
antibiotic prescription
primary health care
cluster-randomized trial
Lead sponsor: University of Bern
Sponsor class: OTHER
Collaborators: name: Bundesamt für Gesundheit
name: Sentinella Netzwerk
name: Schweizerische Gesellschaft für Infektiologie
name: Pädiatrische Infektiologie Gruppe Schweiz
First posted: 2011-05-24
Enrollment: 140
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL

Brief summary: 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: 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.

Eligibility criteria: Inclusion Criteria:

* Patients with respiratory tract infections or urinary tract infections

Exclusion Criteria

* Patients with chronic disease requiring regular antibiotic treatment

Primary outcomes:
measure: Percentage of prescriptions of penicillin for respiratory tract infections
timeFrame: Two years
measure: Percentage of prescriptions of TMP/SMX for lower urinary tract infections in adults
timeFrame: Two years
Secondary outcomes:
measure: Percentage of prescriptions of quinolone for COPD exacerbations in adults
timeFrame: Two years
measure: Percentage of antibiotic prescriptions for the indications "sinusitis" and "other upper respiratory tract infections"
timeFrame: Two years
Other outcomes:
Locations:
city: Bern
country: Switzerland
facility: Institute for Infectious Diseases
Study officials:
affiliation: University of Bern
name: Andreas Kronenberg, Dr. med.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Hurlimann D, Limacher A, Schabel M, Zanetti G, Berger C, Muhlemann K, Kronenberg A; Swiss Sentinel Working Group. Improvement of antibiotic prescription in outpatient care: a cluster-randomized intervention study using a sentinel surveillance network of physicians. J Antimicrob Chemother. 2015 Feb;70(2):602-8. doi: 10.1093/jac/dku394. Epub 2014 Oct 17.