A systematic review and meta-analysis of randomized controlled trials (RCTs) found that audit and feedback (A&F) interventions improved antibiotic prescribing across four outcome metrics in primary care settings, an international team of researchers reported yesterday in Clinical Infectious Diseases.
The reviewers identified 56 RCTs that directly compared antimicrobial stewardship interventions with A&F versus those without A&F and used random-effects meta-analysis to evaluate the evidence across four outcomes: total antibiotic prescribing volume, unnecessary antibiotic initiation, excessive prescription duration, and broad-spectrum antibiotic selection. They also looked at how the effects of A&F interventions varied by study and intervention characteristics.
Reductions of 11% to 23%
They found that A&F was associated with an 11% relative reduction in antibiotic prescribing volume (rate ratio [RR], 0.89; 95% confidence interval [CI], 0.84 to 0.95), a 23% relative reduction in unnecessary antibiotic initiation (RR, 0.77; 95% CI, 0.68 to 0.87), a 13% relative reduction in prolonged duration of antibiotic course (RR, 0.87; 95% CI, 0.81 to 0.94), and a 17% relative reduction in broad-spectrum antibiotic selection (RR, 0.83; 95% CI, 0.75 to 0.93).
Larger reductions were found in low-income compared with high-income countries, and in countries with higher antibiotic use compared with lower antibiotic use. In addition, studies providing monthly feedback, compared with quarterly or annual feedback, also appeared to have greater effect.
Although the study authors caution that heterogeneity was substantial, outcome definitions were not standardized across trials, and intervention fidelity was not consistently assessed, they say the similarity across outcomes is striking.
“Our results contribute to the growing evidence base for the effectiveness of A&F interventions to modify prescribing behaviours for antibiotics in primary care settings,” they wrote.
