Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial

• Published in: Antibiotics (Basel) Vol. 9; no. 8; p. 490
• Main Authors: Sallis, Anna, Bondaronek, Paulina, Sanders, Jet G, Yu, Ly-Mee, Harris, Victoria, Vlaev, Ivo, Sanders, Michael, Tonkin-Crine, Sarah, Chadborn, Tim
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 07-08-2020; MDPI
• Subjects: antibiotic prescribing; antibiotic resistance; Antibiotics; Antimicrobial agents; Antimicrobial resistance; antimicrobial stewardship; Automation; Behavior; Clinical trials; Clusters; commitment posters; Demographics; Demography; Dispensing; Drug resistance in microorganisms; Health risks; Infections; Intervention; Patients; Pharmaceutical research; Population; Primary care; Public health; Randomization; Researchers; Respiratory tract; Respiratory tract diseases; Secondary analysis; United Kingdom; England; commitment posters; primary care; antimicrobial stewardship; antibiotic resistance; antibiotic prescribing
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics9080490

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 (
= 60), CP (
= 66), and CP&AM (
= 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 21.113,
= 0.458; CP&AM, -12.575, 95%CI -30.726 to 5.576,
= 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,
= 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,
= 0.018). Commitment posters did not reduce antibiotic prescribing. An automated patient antimicrobial stewardship message showed effects and requires further testing.