Interventions with Evidence of Improved or Reduced Antibiotic Prescribing and No Increase in Adverse Consequences

Educational Interventions

Prescriptions fell by over 20% when clinic-based educational interventions were aimed at parents of pediatric patients (e.g., posters, pamphlets, interactive videos). Public patient education campaigns combined with clinician education showed a 7% reduction in overall prescribing; no differences in acute otitis media (AOM) complications or patient or parent satisfaction were noted. Evidence for these interventions was moderate for benefits and low for harms.

In addition, public parent education campaigns, without any other intervention, reduced prescribing and subsequent office visits without increasing complications; however the strength of evidence was low for these outcomes.

Point-of-Care Tests

Procalcitonin was the only point-of-care test that showed a benefit in reducing antibiotic prescriptions (12–72%), and this was limited to adults only (moderate strength). No difference in the number of days of limited activity or missing work, or continuing symptoms at 28 days for upper RTI or lower RTI in primary care were noted (low strength). In addition, this intervention was associated with similar adverse events, hospitalizations, treatment failure and mortality (low strength). Because procalcitonin tests require a number of hours, rapid results are unavailable with current tests.

Electronic Decision Support Systems

Electronic decision support systems were associated with a reduction of 5–9% in prescriptions (moderate strength), similar complications (ie, diagnosis of pneumonia within 30 days) and healthcare use (low strength). This reduction was mostly found where the system was used in >50% of cases. The support system also improved appropriate prescribing for acute bronchitis and AOM (moderate strength).