MedWire News: An educational program successfully reduced the rate of antibiotic dispensing in primary care, UK research published in the British Medical Journal shows.
Family practices in Wales that implemented the Stemming the Tide of Antibiotic Resistance (STAR) program dispensed 14 fewer oral antibiotics per 1000 registered patients over the following year.
This compared with an increase of 12 oral antibiotics dispensed per 1000 patients during the same period at practices that did not receive the educational intervention.
The STAR educational program was developed by study authors Christopher Butler (Cardiff University, UK) and colleagues to try to reduce inappropriate antibiotic prescribing in primary care, without increasing costs, reconsultations, or admissions to hospital.
"Despite evidence for little or no benefit in many common conditions, antibiotics continue to be overprescribed in primary care, unnecessarily exposing patients to unwanted effects and selecting for resistant organisms," explain Butler and team.
STAR involves a mixture of learning methods, including a practice-based seminar reflecting on the practices' own dispensing and resistance data, provision of latest research evidence and guidelines, online learning tools, and practice at routine consulting skills. The program can be viewed at www.stemmingthetide.org.
The researchers included 68 general practices with around 480,000 patients in the study. Half the practices were randomized to the STAR intervention, the other 34 to be controls.
Butler and colleagues note that, allowing for the baseline dispensing rate, the net 26-item reduction per 1000 patients per year resulting from the STAR intervention represents a significant 4.2% drop in total oral antibiotic dispensing for all ages and conditions.
Reductions in dispensing were found for all classes of antibiotic other than penicillinase-resistant penicillins, and were largest - and statistically significant - individually for those commonly prescribed in the UK to treat respiratory infections such as sore throat, namely phenoxymethylpenicillins (penicillin V) and macrolides.
The researchers say they found no evidence that antibiotic use was lowered at the expense of increased reconsultations or complications with common infections, "although the study was not powered to identify small changes."
And they estimate that the average cost of the intervention of £ 2923 (US$ 4624; € 3516) per practice would likely be recouped within 3.5 years, based on the observed 5.5% nonsignificant reduction in cost in the intervention group, and assuming the benefit was maintained over time.
Butler and co-authors conclude that their findings "will be of interest to those concerned with antimicrobial stewardship."
Canadian editorialists James McCormack (University of British Columbia, Vancouver) and Michael Allen (University of Alberta, Edmonton) question whether a 4.2% cut in antibiotic use would have a meaningful impact on resistance, however.
They note that most community-acquired infections still respond to the same antibiotics that have been used for decades, and say an alternative policy of delaying prescriptions in uncertain cases may be as effective overall.
Furthermore, data suggest that treatment with high-dose, shorter-duration antibiotics may reduce emergence of resistance, and that shorter courses for self-limiting infections can be just as effective as longer ones.
As it is never clear how an individual patient will respond, however, "a reasonable approach for most primary care infections would be to tell the patient to continue the antibiotic until they have been asymptomatic or afebrile for 72 hours and then to stop," McCormack and Allen write.
"Patients also need to be advised what to do if no improvement is seen within 24-48 hours," they add.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
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