A prospective cluster randomized trial of an interventions bundle to reduce inappropriate antibiotic use for upper...

Antibiotic overuse and increasing antimicrobial resistance are global public health threats. We determined the impact of a multicomponent intervention in reducing inappropriate antibiotic use for upper respiratory tract infections (URTIs) in the outpatient setting.

DESIGN: Prospective, cluster-randomized trial.

Bundled 4-component intervention including extensive provider education, a decision support algorithm, option for deferred antibiotics prescription, and monthly feedback on prescription patterns, vs. a single randomly assigned intervention (decision support algorithm).

Four Primary healthcare centers in Qatar with study period from August 2023 to October 2024.

Individuals with a diagnosis of URTI who were prescribed antibiotics.

Reduction in inappropriate antibiotic prescriptions for URTIs in the intervention vs. control group during the 11-month follow-up period.

We analyzed 20,062 episodes-of-care for URTIs with an antibiotic prescription (9,277 at control and 10,785 at intervention sites). In a mixed effects logistic regression model accounting for the clustering effect, the intervention was associated with a 29% reduction in odds of inappropriate antibiotics prescriptions ( [aOR] 0.71; 95% CI 0.66-0.77). The relative reduction was 20.9% (44.9% vs. 35.5%; p < 0.001) between the two groups. The relative drop in inappropriate antibiotic prescriptions before and after the interventions was 16.3% (42.4% vs 35.5%; p < 0.001) at intervention sites (p < 0.001) compared with 2.2% (45.9% to 44.9%; p = 0.4) at control sites. Senior-most physicians and younger population (19-40 years old) were more likely to prescribe or receive inappropriate antibiotic prescription.

A multi-component intervention can significantly reduce inappropriate antibiotic prescriptions for URTIs in the outpatient setting.

NCT06135376, Registration Date: November 9, 2023.