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Education and feedback improve antibiotic prescribing for children

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3794 (Published 12 June 2013) Cite this as: BMJ 2013;346:f3794

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Researchers from the US have designed and tested a way to discourage primary care doctors from prescribing broad spectrum antibiotics to children with respiratory infections. A single hour of education followed by audit and regular, confidential, and automated feedback reduced inappropriate prescribing by an absolute 6.7% in a cluster randomised trial. Doctors in control practices had no education or feedback, but they did know their prescribing was being tracked. Prescriptions of broad spectrum antibiotics for selected infections fell from 26.8% to 14.3% in intervention practices and from 28.4% to 22.6% in control practices (P=0.01).

The trial lasted a year and looked at prescribing for children with sinusitis, pneumonia, and streptococcal pharyngitis. Doctors in intervention practices were advised to start with amoxicillin or penicillin, in accordance with US guidelines. Prescribing improved steadily during the year and improved most for children with pneumonia. Antibiotic prescribing for viral infections was uncommon to start with and changed little in either group of practices.

All participating paediatricians worked in one of 18 primary care practices with a shared electronic health record and links to local hospitals. Researchers had to exclude prescribing for otitis media—the most common reason for antibiotic prescription in children—because some practices in the network introduced a decision tool during the trial.

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Cite this as: BMJ 2013;346:f3794