Table 5 Summary of key findings from studies assessing changes in antibiotic prescribing and/or usage as key outcome measure
Author | Country | Study Design | Intervention | Comparator | Outcome Measure | Findings |
|---|---|---|---|---|---|---|
Dunais et al. 2011 | France | Cross-sectional | Local intervention aimed at GPs and paediatricians focused on management of uncomplicated RTI’s in children under the age of 6-years. Academic detailing sheets with guidelines were distributed to over 90% of targeted GPs. Run concurrently with National campaign which began 2002. | NA | Antibiotic prescription data. Obtained from child health book or parental questionnaire if health book was not available | Number of children treated with an antibiotic decreased by 50% between 1999 and 2008 with no significant change in the number of average weekly cases of RTI and bronchiolitis reported by GPs between October to April in children aged less than 5 across the three study periods (2.1, 2.4 and 2.2 cases/physician/week respectively). |
Dommergues & Hentgen, 2011 | France | Cross-sectional | National awareness campaign implemented in November 2002 to reduce inappropriate antibiotic use, especially for RTIs in children aged 0-6yrs. Campaign was repeated every winter from 2002. | NA | Annual estimate of prescriptions Annual number of consultations | Number of GP consultations decreased from 14.1 million in 2001 to 10.4 million in 2010. The proportion of consultations leading to antibiotic prescription decreased from 20.1–26.0% in the 2000–2004 period to 13.6–14.6% in the subsequent years. The overall annual number of antibiotic prescriptions in children decreased by 50.4% with greatest reductions in prescribing seen for upper respiratory tract infections. |
Chahwakilian et al. 2011 | France | Cross-sectional | Yearly mass media campaign since autumn 2002. National campaign aiming to inform the public about appropriate ambulatory antibiotic use, with a focus on RTIs. The public campaign was complimented by interventions targeting prescribers. | NA | Antibiotic prescription rates per 1000 inhabitants per year | 21.9% decline in prescriptions per 1000 inhabitants per year (PIY) between 2001 and 2004 which plateaued following 2004. Attributable to a decreasing in primary-care prescribing for RTIs (-39.9%). Decrease was most significant in children < 15 years. Prescriptions per 1000 children per year decreased by 32.1% from 2001 to 2004 and by 15.8% from 2004 to 2009 compared to a 31.1% decline in 15–64-year-olds and a 10.7% decline in > 65 year-olds between 2001 and 2009. Proportion of consultations for RTIs resulting in antibiotic prescriptions decreased from 58% in 2001 to 44% in 2004. This decline was not maintained after 2004. |
Formoso et al. 2013 | Italy | Experimental | Social marketing information campaign between Nov 2011 and Feb 2012 in Moderna and Parma. Focused on the use of antibiotics in RTI. | Control group were provinces in Emilia-Romagna where no campaign had been implemented | Average prescribing rate of antibiotics to outpatients during a 5-month period expressed as DIDs. Change after five months in expenditure on outpatient antibiotics per 1000 inhabitants/day. | During follow-up, average prescribing rates decreased by 11.9 and 7.4% in intervention and control regions respectively. A significant difference (4.3%) in reduction of antibiotics prescribed in the intervention areas compared with control areas was seen A 3.2% decrease was seen in the rest of Italy. Expenditure on antibiotics reduced by 25.1 and 21.8% compared with the same period in the previous year in intervention and control groups respectively. |
Bruyndonckx et al. 2020 | Belgium | Longitudinal | Mass media national awareness campaign aimed at providing the public with a better understanding of the natural course of self-limiting antibiotics, the consequence of AMR, and at facilitating discussion between patients, clinicians, and pharmacists. Key messages changed annually | Pre-campaign data | Outpatient antibiotic use, AMR and cost. Outpatient antibiotic use between 1997 and 2018. Cost of antibiotic use | DID had reduced by 12.8% from 1999–2000 to 2017-18. Cost of antibiotics decreased by 65.3% from 1999–2000 to 2017-18. |
Carlet et al. 2020 | France | Longitudinal | Yearly mass media campaign since autumn 2002. National campaign aiming to inform the public about appropriate ambulatory AB use, with a focus on RTIs. Interventions also targeted prescribers. | NA | Antibiotic consumption in the community (prescriptions per 1000 pop per year). | Initial notable decrease following the first public health campaign, antibiotic consumption in 2016 was 12.6% lower than in 2000. Most notable change was in children who had a far larger reduction (from 2111 to 1000 prescriptions/1000 pop/year in 2000 and 2014). |
Fuertes et al. 2010 | Canada | Longitudinal | “Do Bugs Need Drugs” community education programme. Started in January 2006 with initial television campaign. Key messages included wash your hands, antibiotics work against bacteria not viruses, use antibiotics wisely because bacteria can become resistant to them. | Pre (January 1996 to December 2005) and post (January 2006 to December 2008) | Drug utilisation data, antibiotics dispensed through community pharmacy. Antibiotic utilisation rates for adults (defined daily doses per 1000 pop per day) and children less than 15 years of age (prescriptions per 1000 population per day). | During the three years following program implementation, cumulative observed antibiotic use was 5.8% lower than expected. The observed number of cumulative prescriptions dispensed to children was 10.6% lower than expected. |
McKay et al. 2011 | Canada | Longitudinal | “Do Bugs Need Drugs” community education programme. Started in January 2006 with initial TV campaign. Key messages included wash your hands, antibiotics work against bacteria not viruses, use antibiotics wisely because bacteria can become resistant to them. | Pre and post analysis. | Prescription pads used with patients with RTI symptoms. Monitoring overall antibiotic consumption (1996 to 2008) (Antibiotic consumption rates were expressed in DID). | Significant decrease in use of antibiotics for acute bronchitis (34.6% vs. 21.4%; P = 0.023), and for all indications (45.6% vs. 39.2%; P = 0.019). Consumption of all antimicrobials reached its lowest level in 2002. The rate of use increased between 2002 and 2005, levelling off since 2006. Prior to the programme, the consumption rate for acute otitis media was declining and continued to decrease following implementation of the program. Between 2002 and 2005, DID rate for acute bronchitis increased from 0.68 to 0.94 (39.1%) DID. |
Bernier et al., 2014 | France | Longitudinal | Nationwide public health campaign was launched (“Antibiotics Are Not Automatic!” and “Antibiotics, Used Unnecessarily, Lose Their Potency!”). Repeated annually from October to March since 2002, aimed to decrease prescriptions in the community, particularly for children | “campaign” period (October to March), coincides with the targeted public service campaign, compared to the second, the “warm” period, corresponds to April to September | Aggregated 2000–2010 data on all outpatient antibiotics prescribed. Data presented as weekly rates of antibiotics prescriptions per 1,000 inhabitants. | Greatest decrease in prescribing during campaign periods was seen from 2006-7 (30%). After this, reductions were smaller (25 to 27%) but still significant compared to baseline. Similar trend found in children from all age groups (0-5-years: -33%; 6-15years: -24%) and adults (16–60 age group) (-17%), p < 0.0001. Trend differed for older adults (> 60-yrs) with fluctuations around baseline values and only two significant decreases, with the largest being observed in 2006 to 2007 (− 9.0% [95% CI: −14.9, − 3.2%]; P = 0.004). |
Kandeel et al. 2019 | Egypt | Pilot | Campaign aimed to raise awareness of the importance appropriate prescribing. Social media campaign and posters displayed in GP waiting areas, pharmacies, community areas, schools and unis. Training and RTI management guidelines for HCPs. | Pre and post | Self-reported antibiotic prescribing practices antibiotic prescribing practices | 25% decrease overall in antibiotic prescribing post-intervention for children and a 22% decrease in prescribing for adults which were mainly driven by reductions in prescribing for ear infections and bronchitis. The percentage of physicians who reported commonly prescribing antibiotics for RTIs decreased following the intervention (colds: 9.3 to 2.1%, bronchitis: 65.8 to 28.4% and sinusitis: 43.5 to 17.0%). The percentage of pharmacists prescribing AB (83.6 to 57.7%) or recommending antibiotics (57.8 to 24.8%) for ARI also declined. |
Filippini et al. 2012 | Europe | Pooled analysis | Countries that adopted some policy measures. | Countries that did not introduce any policy instrument to reduce antibiotic consumption | Consumption rate of antibiotics expressed as DID. | Implementation of a public campaign may reduce antibiotic consumption by 1.3–5.6 DID. This represents an impact of roughly 6.5–28.3% on the mean level of antibiotic use in Europe between 1997 and 2007. |
Furst et al. 2015 | Slovenia | Quasi- observational | Educational materials provided to the public including flyers on ‘safe use of drugs’, ‘My child has fever’, ‘Get well without Abs’, ‘Interactions of drugs’. Other interventions aimed at HCP include prescribing restrictions workshops, budget targets etc. | Pre and post | AB utilisation. AB resistance | From 1999 to 2012, antibiotic use decreased by 31%, following a 24% increase from, 1995 to 1999. Within the time period 1999–2012, the consumption of antibiotics with prescribing restrictions was reduced on average by 42% and that of non-restricted ones was reduced by 15%. Between 1999 and 2012, the penicillin resistance in invasive S. pneumoniae isolates decreased from 14.5 to 10%. The resistance of S. pneumoniae to macrolides increased from 5.4 to 21%. The resistance of E. coli to fluoroquinolones continuously increased from 10 to 21%. |
Plachouras et al. 2014 | Greece | Quasi-experimental | Public education campaign and academic detailing of the primary care physicians in the district of Corinth. Seventeen two-hourly educational meetings were organized with parents of children in nursing care and primary school. Following this, parents were given an educational pamphlet on the use of antibiotics for common infections in the community. | The rest of districts in Peloponnese and the national rate served as controls. Data was compared before and after the campaign. | Antibiotic consumption data, antibiotics prescribed for RTIs were included in the study | Antibiotic utilization in the test region (Corinth) was unchanged in January and February 2009 at 26 DID and increased to 32 DID in March 2009, reflecting control region trends. |
Morgan et al., 2021 | USA | Quasi-experimental | Educational sessions, sharing of data by clinics, and patient and physician educational materials. The intervention period began with resident education and staff meetings. | Pre post comparison using time series analysis. | Number of antibiotic prescriptions written for antibiotic nonresponsive RTI | Average of 166 eligible visits per month. The percentage of visits that resulted in a prescription for an antibiotic unresponsive RTI reduced from 11.5 to 5.8%. Immediate intervention effect indicated a 46% reduction in antibiotic nonresponsive ARI antibiotic prescriptions or 0.54 times (95% CI, 0.42–0.66; P = 0.001) as many antibiotic nonresponsive RTI antibiotics prescribed after the intervention. Long term intervention effect showed a statistically significant trend in the number of antibiotic-nonresponsive RTI antibiotics prescribed across all clinics |