Educational interventions to improve prescription and dispensing of antibiotics: a systematic review

Roque, Fátima; Herdeiro, Maria Teresa; Soares, Sara; Teixeira Rodrigues, António; Breitenfeld, Luiza; Figueiras, Adolfo

doi:10.1186/1471-2458-14-1276

BMC Public Health

Table 3 Interventions to improve antibiotic use in hospital settings

From: Educational interventions to improve prescription and dispensing of antibiotics: a systematic review

Author (year)	Study design (a)	Program description		Baseline and follow-up			Analysis (d)	Results (e)
Author (year)	Study design (a)	Disease	Intervention type (b, c)	Baseline	Intervention period	Follow-up
Deuster, S (2010) [3]	1	Most common hospital infections	IG: 1, 2	8 weeks	8 weeks	8 weeks (1 year after)	5	Ga (+) (−)^a
Chang, MT (2006) [67]	1	___	IG: 1, 7	3 months	3 months	___	2	T (+)
Chang, MT (2006) [67]	1	___	IG: 1, 7	3 months	3 months	___	2	Ga (+)
Naughton, BJ (2001) [68]	4	Pneumonia	IG: 1, 2	6 months	6 months	___	2, 3	T (−)
Naughton, BJ (2001) [68]	4	Pneumonia	CG: 1, 2	6 months	6 months	___	2, 3	T (−)
Lutters, M (2004) [69]	1	RTI and UTI	IG: 1, 2, 4	12 months	24 months	___	2	T (+)
Lutters, M (2004) [69]	1	RTI and UTI	IG: 1, 2, 4	12 months	24 months	___	2	Ga (+)
Loeb, M (2005) [70]	4	UTI	IG: 1, 2, 4	___	___	___	1	T (+)
Loeb, M (2005) [70]	4	UTI	CG: 0	___	___	___	1	T (+)
Lesprit, P (2009) [71]	2	Various	IG: 1, 2, 12	___	8 weeks	___	1	Ga (+)
Lesprit, P (2009) [71]	2	Various	CG: 1, 2	___	8 weeks	___	1	Ga (+)
Akter, SFU (2009) [72]	2	Common pediatric infections	IG: 2	4 months	4 months	___	2, 3	T (+)
Akter, SFU (2009) [72]	2	Common pediatric infections	IG: 2	4 months	4 months	___	2, 3	Ga (+)
Paul, M (2006) [73]	5	___	IG: 6	7 months	7 months	___	1, 2	Ga (+)
Paul, M (2006) [73]	5	___	CG: 0	7 months	7 months	___	1, 2	Ga (+)
Camins, BC (2009) [74]	4	___	IG: 1, 3, 4	___	10 months	___	1	Ga (+)
Camins, BC (2009) [74]	4	___	CG: 1 (guidelines)	___	10 months	___	1	Ga (+)
Westphal, JF (2010) [75]	1	Pneumonia	IG: 2, 5, 6	18 months	54 months	___	2	Ga (+) (−)^b
Mullet, CJ (2001) [76]	1	___	IG: 6	6 months	6 months	___	2	T (+) (−)^c
Mullet, CJ (2001) [76]	1	___	IG: 6	6 months	6 months	___	2	Ga (+)
von Gunten, V (2005) [77]	5	___	IG_B: 1	6 months	6 months	___	2, 3	T (+)
			IG_C: 1, 2, 12					Ga (+)
			CG_A: 0					Ga (+)
Ansari, F (2003) [78]	1	___	IG: 12	24 months	24 months	___	2	Ga (+) (−)^d
Ansari, F (2003) [78]	1	___	IG: 12	24 months	24 months	___	2	T (+)
Kisuule, F (2008) [79]	1	___	IG: 1, 3, 4	Period until 20 prescriptions	2 months	1 month	2	Ga (+)
Halm, EA (2004) [80]	1	Pneumonia	IG: 1, 2, 8, 9	5 months	---	5 months	2	Ga (+)
López-Medrano, F (2005) [81]	1	___	IG: 12	12 months	12 months	___	2	T (+)
López-Medrano, F (2005) [81]	1	___	IG: 12	12 months	12 months	___	2	Ga (+)
Agwu, AL (2008) [82]	1	___	IG: 6, 12	12 months	12 months	___	2	Ga (+)
Barenfanger, J (2001) [83]	4	___	IG: 6	___	5 months	___	1	T (+)
Barenfanger, J (2001) [83]	4	___	CG: 0	___	5 months	___	1	T (+)
Rüttiman, S (2004) [84]	1	___	IG: 1, 2, 3	___	___	___	2	T (+) Ga (+)
Martin, C (2005) [85]	1	Pneumonia	IG: 1, 2	___	60 months	___	2	Ga (+)
		Meningitis
		UTI
Solomon, DH (2001) [86]	4	___	IG: 1, 3, 4, 12	4 weeks	18 weeks	___	2, 3	Ga (+)
Solomon, DH (2001) [86]	4	___	CG: 0	4 weeks	18 weeks	___	2, 3	Ga (+)
Fowler, S (2007) [87]	1	___	IG: 1, 3	21 months	21 months	___	2	Ga (+)
Sintchenko, V (2005) [88]	1	Intensive care	IG: 6	6 months	6 months	___	2	T (+) Ga (+)
Yong, MK (2010) [89]	1	Intensive care	IG: 6	30 months	54 months	___	2	Ga (+)
Meyer, E (2010) [90]	1	Intensive care	IG: 2	24 months	36 months	___	2	T (+)
Thursky, KA (2006) [91]	1	Intensive care	IG: 2, 6	6 months	6 months	___	2	T (+) Ga (+)
Petterson, E (2011) [92]	4	UTI	IG = 1, 2, 3	3 months	3 months		2, 3	T (+)
Petterson, E (2011) [92]	4	UTI	CG = 0	3 months	3 months		2, 3	Ga (+)
Tangden, T (2011) [93]	1	Pneumonia (Intravenous)	IG = 1, 2	7 years		2.5 years	3	T (+)
Tangden, T (2011) [93]	1	Pneumonia (Intravenous)	IG = 1, 2	7 years		2.5 years	3	Ga (+) (−)^e
Talpaert, MJ (2011) [94]	1	___	IG = 2	12 months	12 months		3	T (+) (−)^f
Bevilacqua, S (2011) [95]	2	___	IG = 3, 7, 12	12 months	12 months		2, 3	Ga (+)
Bevilacqua, S (2011) [95]	2	___	CG = 0	12 months	12 months		2, 3	Ga (+)
Shen, J (2011) [96]	2	Bronchitis	IG = 12		10 months		1	Ga (+)
		Community acquired pneumonia	CG = 0
		Acute exacerbation of COPD

^a In[3], the follow-up analysis showed sustained adherence to guidelines in hospital-acquired pneumonia but a decrease in guideline adherence in the case of UTI.
^b In[75], there was a significant decrease in the proportion of antibiotic orders containing at least one criterion that was not in line with the guideline, but the choice of antibiotics according to the context of acquisition of pneumonia, improvement was not statistically significant.
^c In[76], total of antibiotics used was similar but the number of orders placed per antibiotic course decreased post-intervention.
^d In[78], there was a significant decrease in use of total and alert antibiotics, except in the case of ceftriaxone and mercapen.
^e In[93], there was a reduction of cefalosporines consumption, but pipiracillin/tazobactan and penicillin increased
^f In[94], there was a reduction in fluorquinolone and cefalosporine but no significant change total of antibiotics neither clindamicine, amoxiciline and co-amoxclav use.
(a) Disease: URTI – upper respiratory tract infections; RTI – respiratory tract infections; ARTI – acute respiratory tract infections; UTI – urinary tract infections; COPD-Chronic obstructive pulmonary disease.
(b) Study design (SD): (1) before/after studies; (2) – nonrandomized controlled trial without cross-contamination control; (3) – nonrandomized controlled trial with cross-contamination control; (4) - randomized controlled trial without cross-contamination control; (5) - randomized controlled trial with cross-contamination control.
(c) IG – intervention group; CG – control group.
(d) Type of intervention (TI): (0) no intervention; (1) dissemination of printed/audiovisual educational materials (mailed printed matter; protocols and guidelines; self-instruction materials; drug bulletins); (2) group education, including group-session rounds, conferences, lectures, seminars and tutorials; (3) feedback of physician prescribing patterns (individually or including a comparison of these patterns with peer behavior and/or accepted standards) or feedback of patient-specific lists of prescribed medication; (4) individual outreach visits; (5) reminders at the time of prescribing; (6) computer-assisted decision-making systems; (7) formulary-control/restrictive formulary process; (8) patient education (pamphlets); (9) patient education (videotapes); (10) workshops on rapid tests / introduction of Rapid Antigen Detection Tests (RADTs) in consulting offices; (11) enforcement of regulations; (12) prescription feedback with recommendations to modify it by pharmacists and/or infectious-disease physicians; (13) financial incentives.
(e) Type of data-analysis (T): (1) comparison of post-test values between groups; (2) comparison of pre- and post-values within each group; (3) comparison of pre- and post-values between groups; (4) comparison of follow-up values between groups; (5) comparison of pre-, post- and follow-up values within each group; (6) comparison of pre-, post- and follow-up values between groups.
(f) Results analyzed (R): (T) total antibiotics prescribed/dispensed; (Ga) choice of appropriate antibiotics/adherence to antibiotic guidance according to guideline algorithms, including dosages and routes of administration; (Pa) prescription rate per pathology: (At/Bh) attitudes and behavior; (Qph) quality of pharmacy practice.

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