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Patient education may reduce unnecessary use of antibiotics by adults

Over half of antibiotic prescriptions for acute respiratory infections (ARIs) such as sore throats (pharyngitis) and acute bronchitis are not necessary, since most of these infections are viral and do not respond to antibiotics. A recent study examined the effects of patient education on antibiotic prescribing for adults with acute bronchitis and children with pharyngitis. The study was supported in part by the Agency for Healthcare Research and Quality (HS13001).

Researchers led by Ralph Gonzales, M.D., M.S.P.H., of the University of California, San Francisco, found that adding patient education strategies to an existing physician education quality improvement (QI) program (doctors were given antibiotic prescribing profiles and practice guidelines) nearly doubled the decrease in unnecessary antibiotic prescribing for acute bronchitis in adults compared with the QI program alone (control practices). The intervention had a negligible effect on antibiotic prescribing for pediatric pharyngitis.

The researchers examined antibiotic prescription rates based on ARI office visit and pharmacy claims data from four Colorado managed care organizations during baseline (winter 2000) and study (winter 2001) periods. Antibiotic prescription rates for pediatric pharyngitis increased during the 1-year period from 38 to 39 percent at distant control practices, decreased from 39 to 37 percent at local control practices, and decreased from 34 to 30 percent at intervention practices. Antibiotic prescription rates for adult bronchitis decreased from 50 to 44 percent at distant control practices, from 55 to 45 percent at local control practices, and from 60 to 36 percent at intervention practices.

For pediatric pharyngitis, antibiotic treatment is recommended only when the infection is due to group A Streptococcus. Because the prevalence of group A Streptococcus in children has been estimated at 30 to 35 percent of all visits for pharyngitis, there appears to be little room for improvement in this group.

See "The `Minimizing Antibiotic Resistance in Colorado' project: Impact of patient education in improving antibiotic use in private office practices," by Dr. Gonzales, Kitty K. Corbett, Ph.D., M.P.H., Bonnie A. Leeman-Castillo, M.S., and others, in the February 2005 Health Services Research 40(1), pp. 101-116.

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