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Education campaign reduces antibiotic prescribing by emergency department physicians for upper respiratory tract infections

Despite the fact that antibiotics have little effect on chest colds and bronchitis, emergency department (ED) physicians still often prescribe them. Researchers at the University of Pennsylvania School of Medicine Center for Education and Research on Therapeutics, along with colleagues from the Philadelphia VA Medical Center and the University of California, San Francisco, created an education campaign for clinicians and patients and evaluated its effectiveness in reducing antibiotic prescribing for upper respiratory tract infections.

Similar education campaigns carried out in primary care settings have reduced antibiotic overuse for respiratory infections an average of 12 to 26 percent. Clinicians at 16 Veterans Administration (VA) and non-VA hospitals received 4-hour education sessions, journal articles, and a slide presentation on appropriate use of antibiotics for respiratory tract infections.

To educate patients on the perils of overusing antibiotics, the researchers provided brochures, posters in treatment and waiting rooms, and computer kiosks with tailored audiovisual educational modules in English and Spanish. During year one, about half of ED patients with acute respiratory infections and bronchitis were prescribed antibiotics in control sites (47 percent) and intervention sites (52 percent). However, antibiotic prescriptions declined an average of 10 percent at the eight intervention sites between year one and two but did not decline at control sites. For four intervention sites, the decrease was between 10 and 20 percent. This reduced antibiotic prescribing did not increase return visits to the ED or lessen patient satisfaction.

The researchers speculate that patients in the ED may be more prone to be treated with antibiotics because they often lack access to primary care services. This study was funded in part by the Agency for Healthcare Research and Quality (HS13915).

See "Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments," by Joshua P. Metlay, M.D., Ph.D., Carlos A. Camargo, Jr., M.D., Dr.P.H., Thomas MacKenzie, M.D., M.S.P.H., and others in the September 2007 Annals of Emergency Medicine 50(3), pp. 221-230.

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