engleski

Interventions to Improve Antibiotic Prescribing in Ambulatory Care

Bacterial resistance to antibiotics is a major public health problem, increasing morbidity and mortality as well as healthcare costs. Since the introduction of antimicrobial agents there has been an association between antibiotic use and resistance. The overuse of antibiotics, in particular, inappropriate use to treat upper respiratory tract infections (URTI) is a global public health concern. Most of these infections are viral in origin and are self-limiting. Despite this, up to 75% of patients with URTI are prescribed antibiotics. There are many clinical and non-clinical factors contributing to inappropriate or unnecessary antibiotic use. These include doctor and consumer knowledge, percieved patient demand, pressure of promotion, fear of poor clinical outcomes, local medical culture and supply mechanisms, workload of general practitioners and others. In an attempt to address the complex patient-clinician relationship and reduce inappropriate use of antibiotics for URTIs many different interventions have been introduced accross different healthcare systems. They may target prescribers, consumers or both and may be single or multi-faceted. The mostly used programs to discourage the practice of prescribing antibiotics for acute nonbacterial illnesses in the outpatient setting involve the following interventions: clinician education alone ; delayed prescription (clinician advice to use the antibiotic prescription only if symptoms did not improve or grew worse) ; patient education alone ; clinician education plus patient education ; clinician education, patient education, and chart audits with feedback to clinicians ; clinician education plus chart audit/feedback ; clinician education with reminders plus patient education ; patient education with chart audit/feedback for clinicians. No isolated intervention has been shown to be superior over the others but integrated prescriber and consumer interventions seem to be effective in reducing inappropriate antibiotic prescribing.

antibiotics; improving prescribing; campaign

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