Tracking and Reporting
For Healthcare Professionals
Monitor antibiotic prescribing practices and offer regular feedback to clinicians, or have clinicians assess their own antibiotic prescribing practices themselves.
Audit and Feedback
|Reference||Interventions and Outcomes||Methods, Participants, and Settings||Results||Conclusions|
|Gerber JS, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: A randomized trial. JAMA 2013. 309(22): 2345–52.
Gerber JS, et al. Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback. JAMA 2014; 312(23): 2569–2570.
|InterventionQuarterly audit and feedback on antibiotic prescribing practices for sinusitis, pharyngitis, and pneumonia with peer comparisons
One hour of clinician education
Broad-spectrum antibiotic prescribing rates for sinusitis, pharyngitis, and pneumonia
Antibiotic prescribing for viral infections
|MethodsCluster randomized controlled trial
Pediatric primary care providers
18 pediatric primary care practices in the United States (New Jersey)
|Intervention group showed a reduction in broad-spectrum antibiotic prescribing compared with controls with6.7% difference in differences.
No change in group A Streptococcus pharyngitis prescribing or for viral infections, which were both relatively appropriate at baseline.
Broad-spectrum prescribing returned to baseline rates once audit-and feedback stopped.
|Audit and feedback with peer comparisons and with clinician education led to decreases in non-recommended broad-spectrum antibiotic prescribing.
Benefits were not sustained once the audit-and-feedback ended.
|Meeker et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: A randomized clinical trial. JAMA 2016;315(6):562–70.||Interventions3 behavioral interventions
Suggested alternatives to antibiotics placed within electronic health records for these diagnoses
Accountable justification required in medical record for non-recommended antibiotic prescribing
Peer comparison to top-performing peers
Rate of antibiotic prescribing for acute respiratory tract infections for which antibiotics are not indicated
|MethodsCluster randomized clinical trial
248 primary care clinicians
47 primary care practices in the United States
|31,712 visits for acute respiratory tract infections for which antibiotics are not indicated:
Antibiotic prescribing decreased from:
Compared with the control group, no intervention showed significant diagnosis shifting.
|Accountable justification and peer comparison interventions reduced antibiotic prescribing for acute respiratory tract infections for which antibiotics are not indicated|
|Butler CC, et al. Effectiveness of multifaceted educational program to reduce antibiotic dispensing in primary care: Practice based randomized controlled trial. BMJ 2012. 344:d8173.||InterventionMultifaceted clinician education, including communication skills, targeting antibiotic prescribing versus standard care
Audit and feedback of practice antibiotic dispensing data
Primary: total number of antibiotics dispensed per 1000 patients by practice
Secondary: return visits and hospital admissions for respiratory tract infections, and cost
|MethodsRandomized controlled trial
General practices in United Kingdom (Wales)
|68 practices serving 480,000 patients
A 4.2% reduction in total antibiotic prescribing was observed in the intervention group compared with controls in one year (p = 0.02).
No differences in hospital admissions or return visits for respiratory tract infections were observed between the intervention and control groups.
5.5% non-significant decreased in antibiotic dispensing cost in intervention group compared with controls.
|A clinician educational intervention led to reductions in antibiotic dispensing with no changes in hospital admissions, return visits, or costs.|
|Finkelstein JA, et al. Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts. Pediatrics 2008. 121(1):e15–23.||InterventionMulti-faceted intervention with clinician education, parent education, and audit and feedback on antibiotic prescribing
Overall oral antibiotic dispensing per person-year of observation for children 3 to <72 months of age
|MethodsCommunity-level cluster-randomized controlled trial
Clinicians, parents, and pediatric patients aged 6 years or younger
Non-overlapping communities in the United States (Massachusetts)
|16 communities with 223,135 person-years observed
Decreasing antibiotic prescribing was seen in all groups, including controls, during study period.
Intervention led to 4.2% decrease in overall antibiotic prescribing among children 24 to <48 months old and 6.7% among children 48 to <72 months old compared with control communities.
No difference in antibiotic prescribing for intervention or control communities for children aged 3 to <24 months.
|A large community intervention modestly decreased antibiotic use.
|Metlay JP, et al. Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Ann Emerg Med 2007. 50(3):221–30.||InterventionClinician and patient education
Audit and feedback on prescribing practices for upper respiratory infections (URIs) and acute bronchitis
Primary: Proportion of patients URIs and acute bronchitis with antibiotic prescribed
Secondary: antibiotic prescribing for antibiotic-appropriate respiratory infections, return ED visits within 2 weeks, and hospital admission within 2 weeks
|MethodsCluster-randomized controlled trial
Emergency department (ED) clinicians and patients
Hospital EDs, including veterans and non-veterans hospitals in the United States
|16 EDs with 5,665 visits by adults for acute respiratory infections
Intervention sites had a significant decrease in antibiotic prescribing for URIs and acute bronchitis (-10%; 95% CI -18 to -2%), compared with no change in control sites (0.5% 95% CI -3 to 5%).
No significant increases in emergency department return visits or patient satisfaction was observed among control or intervention sites.
|Multifaceted education interventions combined with audit and feedback can decrease antibiotic prescribing for ED patients with URIs and acute bronchitis.|
|Hallsworth M, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomized controlled trial. The Lancet 2016. 387:1743–52
|InterventionsAudit and feedback as a letter from England’s Chief Medical Officer sent to the high-prescribing practices defined as the top 20% for their National Health Service (NHS) Local Area Team versus no communication
Patient education materials versus no materials
Rate of antibiotics dispensed per 1000 weighted population, controlling for past prescribing
|MethodsPragmatic factorial randomized controlled trial
Analysis by intention-to-treat
General practitioners (GP)
GP practices NHS clinics across England
Letters sent to 3227 GPs
Intervention group had 126.98 antibiotics dispensed per 1000 population versus and 131.25 antibiotics dispensed per 1000 population in the control group (difference of 3.3%, p<0.001).
Estimated 73,406 fewer antibiotics dispensed in intervention group.
No difference in antibiotic prescribing for patient educational materials.
|Audit and feedback from an important figure (e.g., England’s Chief Medical Officer) reduced antibiotic prescribing at the national level.