Educational intervention to optimise antibiotic prescribing: a narrative review of recent evidence

Antimicrobial stewardship (AMS) interventions aim to optimise prescribing practices and tackle antimicrobial resistance. Since 2019, the Centers for Disease Control and Prevention (CDC) have included education as a core element of AMS programmes. This narrative review synthesises recent evidence (2019-2025) on educational interventions targeting healthcare professionals to improve antibiotic use. A systematic search across databases identified 78 eligible studies conducted in different countries and clinical settings. Most interventions (N = 58) focused on clinical knowledge transfer, such as appropriate antibiotic selection, treatment duration, and guidelines adherence. Only a minority (N = 20) addressed psycho-social and behavioural aspects, including communication with patients or shared decision-making. This gap was reflected in the profile of education providers, primarily clinical experts such as infectious disease specialists or pharmacists, and in the limited use of behavioural or theoretical frameworks. Educational strategies frequently included traditional training sessions and audit and feedback. Although several studies reported improvements in prescribing behaviours, long-term sustainability and implementation fidelity were rarely assessed. Despite increasing recognition of the role of behavioural and psycho-social factors in shaping prescribing practices, these dimensions remain largely absent from educational content. To foster sustainable change, future AMS programmes should adopt theory-informed designs, incorporate psycho-social and behavioural dimensions. Strengthening these aspects is essential to support healthcare professionals in navigating the complex realities of prescribing decisions and to achieve long-term reductions in inappropriate antibiotic use.