A prospective cluster randomized trial of an interventions bundle to reduce inappropriate antibiotic use for upper respiratory tract infections in the outpatient setting

BMC Infect Dis. 2025 Jul 1;25(1):818. doi: 10.1186/s12879-025-11210-z.

Abstract

Background: Antibiotic overuse and increasing antimicrobial resistance are global public health threats. We determined the impact of a multicomponent intervention in reducing inappropriate antibiotic use for upper respiratory tract infections (URTIs) in the outpatient setting.

Methods: DESIGN: Prospective, cluster-randomized trial.

Intervention: Bundled 4-component intervention including extensive provider education, a decision support algorithm, option for deferred antibiotics prescription, and monthly feedback on prescription patterns, vs. a single randomly assigned intervention (decision support algorithm).

Setting: Four Primary healthcare centers in Qatar with study period from August 2023 to October 2024.

Participants: Individuals with a diagnosis of URTI who were prescribed antibiotics.

Main outcome(s): Reduction in inappropriate antibiotic prescriptions for URTIs in the intervention vs. control group during the 11-month follow-up period.

Results: We analyzed 20,062 episodes-of-care for URTIs with an antibiotic prescription (9,277 at control and 10,785 at intervention sites). In a mixed effects logistic regression model accounting for the clustering effect, the intervention was associated with a 29% reduction in odds of inappropriate antibiotics prescriptions ( [aOR] 0.71; 95% CI 0.66-0.77). The relative reduction was 20.9% (44.9% vs. 35.5%; p < 0.001) between the two groups. The relative drop in inappropriate antibiotic prescriptions before and after the interventions was 16.3% (42.4% vs 35.5%; p < 0.001) at intervention sites (p < 0.001) compared with 2.2% (45.9% to 44.9%; p = 0.4) at control sites. Senior-most physicians and younger population (19-40 years old) were more likely to prescribe or receive inappropriate antibiotic prescription.

Conclusion: A multi-component intervention can significantly reduce inappropriate antibiotic prescriptions for URTIs in the outpatient setting.

Gov id: NCT06135376, Registration Date: November 9, 2023.

Keywords: Antibiotics; Inappropriate; Primary care; Upper respiratory tract infection.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents* / therapeutic use
  • Antimicrobial Stewardship
  • Child
  • Female
  • Humans
  • Inappropriate Prescribing* / prevention & control
  • Inappropriate Prescribing* / statistics & numerical data
  • Male
  • Middle Aged
  • Outpatients
  • Prospective Studies
  • Qatar
  • Respiratory Tract Infections* / drug therapy
  • Young Adult

Substances

  • Anti-Bacterial Agents

Associated data

  • ClinicalTrials.gov/NCT06135376