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Key findings:

• A new Cochrane Overview has identified effective and safe clinician-focussed interventions to reduce antibiotic prescribing for acute respiratory infections (ARIs) in primary care.
• The authors found that point-of-care CRP testing, procalcitonin-guided management and shared decision making probably safely reduce antibiotic prescribing in the management of ARIs compared to usual care.
• There were no trials in the included reviews which compared interventions against one another, so we do not know which is most effective at reducing antibiotic prescribing for ARIs in primary care.

 Context:

•  Antibiotic resistance has become a major public health problem, with some infections no longer treatable using currently available drugs. The inappropriate use of antibiotics is associated with the increase of resistance.
•  Most antibiotics are prescribed in primary care, and most commonly for ARIs. In most cases ARIs seen in primary care are spontaneously resolved without antibiotics.
• The management of ARIs in primary care is therefore a key target for influencing the antibiotic prescribing behaviour of clinicians.

What does the review say?:

• The authors identified eight systematic reviews assessing clinician-focussed interventions to influence antibiotic prescribing for ARIs in primary care, containing a total of 44 trials.
• Moderate-quality evidence suggests that the following interventions probably have an important effect on reducing antibiotic prescribing in primary care:
  • C-reactive protein point-of-care testing in general practice probably reduces antibiotic prescribing with little or no effect on symptom duration, patient satisfaction, or reconsultation;
  • shared decision making in the management of ARI in general practice probably reduces antibiotic prescribing without increasing likelihood of reconsultation, and may maintain patient satisfaction;
  • procalcitonin-guided management of ARI in probably reduces antibiotic prescribing in general practice and emergency departments without affecting health-related quality of life and whilst avoiding treatment failure.

• There were no trials in the included reviews which compared these interventions against one another, so we do not know which is the most effective.
• For the other interventions, including multifaceted interventions, those centred on clinician education, patient information leaflets, and the use of rapid viral diagnostics, the evidence was of low or very low quality across outcomes, and we could not confidently draw any conclusions about the effects of these interventions compared to usual care. Further primary research is necessary to improve the evidence base in order to be able to make informed decisions about the value of these interventions.
• None of the trials in the included reviews reported on management costs for the treatment of an ARI or any associated complications, so it was difficult to weigh the benefits and costs of implementing these interventions in practice.
• Most of this research was undertaken in high-income countries, and it may not generalize to other settings.

Get access to this Cochrane Overview online: Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews