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Antibiotics 2017, 6(4), 38; doi:10.3390/antibiotics6040038

Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America—Cluster Randomized Controlled Trial

The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
Dr. Pedro Baliña Hospital, Public Health Ministry, Posadas 3300, Misiones, Argentina
Policlínica Central de la Caja Nacional de Salud, La Paz 15000, Bolivia
Department of Family and Community Medicine, Faculty of Medicine, University of the Republic, Montevideo 11600, Uruguay
Author to whom correspondence should be addressed.
Academic Editor: Jeffrey Lipman
Received: 27 September 2017 / Revised: 5 December 2017 / Accepted: 11 December 2017 / Published: 14 December 2017
(This article belongs to the Special Issue Top 35 of Antibiotics Travel Awards 2017)
View Full-Text   |   Download PDF [540 KB, uploaded 14 December 2017]   |  


High antibiotic prescribing and antimicrobial resistance in patients attending primary care have been reported in South America. Very few interventions targeting general practitioners (GPs) to decrease inappropriate antibiotic prescribing have been investigated in this region. This study assessed the effectiveness of online feedback on reducing antibiotic prescribing in patients with suspected respiratory tract infections (RTIs) attending primary care. The aim was to reduce antibiotic prescribing in patients with acute bronchitis and acute otitis media. Both are RTIs for which antibiotics have a very limited effect. A cluster randomized two-arm control trial was implemented. Healthcare centres from Bolivia, Argentina, Paraguay and Uruguay participating in the quality improvement program HAPPY AUDIT were randomly allocated to either intervention or control group. During ten consecutive weeks, GPs in the intervention group received evidence-based online feedback on the management of suspected RTIs. In patients with acute bronchitis, the intervention reduced the antibiotic prescribing rate from 71.6% to 56% (control group from 61.2% to 52%). In patients with acute otitis media, the intervention reduced the antibiotic prescribing from 94.8% to 86.2% (no change in the control group). In all RTIs, the intervention reduced antibiotic prescribing rate from 37.4% to 28.1% (control group from 29% to 27.2%). Online evidence-based feedback is effective for reducing antibiotic prescribing in patients with RTIs attending primary care in South America. View Full-Text
Keywords: antibiotics; educational intervention; general practice antibiotics; educational intervention; general practice

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Urbiztondo, I.; Bjerrum, L.; Caballero, L.; Suarez, M.A.; Olinisky, M.; Córdoba, G. Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America—Cluster Randomized Controlled Trial. Antibiotics 2017, 6, 38.

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