Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2022
Improving Outpatient Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: A Stepped-Wedge Cluster Randomized Trial.
Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 4 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Digital patient safety interventions in primary care: a systematic review and meta-analysis.BMC medicine · 2026Pooled it
- Effectiveness of interactive dashboards to optimize prescribing in general practice: a systematic review.Family practice · 2025Pooled it
- Audit and feedback: effects on professional practice.The Cochrane database of systematic reviews · 2025Pooled it
- Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Pooled it
- Mailed feedback to primary care physicians on antibiotic prescribing for patients aged 65 years and older: pragmatic, factorial randomised controlled trial.BMJ (Clinical research ed.) · 2024Trial
- Review
- Mixed-method evaluation of interactive provider dashboards for comparison of outpatient antibiotic prescribing for respiratory and otic conditions in walk-in clinics.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- The influence of social relationships on clinician interpretation of performance data in an outpatient antibiotic stewardship intervention.Antimicrobial resistance and infection control · 2025Article
- Article
- Current Evidence and Gaps for Outpatient Respiratory Tract Infection Diagnostics: A Call to Action.Open forum infectious diseases · 2025Article
- A Pilot Study Evaluating the Impact of an Algorithm-Driven Protocol on Guideline-Concordant Antibiotic Prescribing in a Rural Primary Care Setting.Pharmacy (Basel, Switzerland) · 2025Article
- Changing the antibiotic prescribing of Australian general practice registrars' for acute respiratory tract infections: a non-randomized controlled trial.Family practice · 2025Article
- Therapeutic approaches for septicemia induced by multidrug-resistant bacteria using desert-adapted plants.Frontiers in cellular and infection microbiology · 2025Article
- Perception of antimicrobial stewardship interventions in Swiss primary care: a mixed-methods survey.BJGP open · 2025Article
- Effectiveness of different de-implementation strategies in primary care: systematic review and meta-analysis.BMJ medicine · 2025Article
- Optimal Pediatric Outpatient Antibiotic Prescribing.JAMA network open · 2024Article
- Antibiotic Prescribing Patterns for Respiratory Tract Illnesses Following the Conclusion of an Education and Feedback Intervention in Primary Care.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors.JAMA network open · 2024Article
- Adaptation and validation of an antibiotic prescribing, peer comparison metric for respiratory tract diagnoses in walk-in clinics: a mixed-methods analysis.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Next Steps in Ambulatory Stewardship.Infectious disease clinics of North America · 2023Review
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInappropriate antibiotic prescribing is common in primary care (PC), particularly for respiratory tract diagnoses (RTDs). However, the optimal approach for improving prescribing remains unknown.
methodsWe conducted a stepped-wedge study in PC practices within a health system to assess the impact of a provider-targeted intervention on antibiotic prescribing for RTDs. RTDs were grouped into tiers based on appropriateness of antibiotic prescribing: tier 1 (almost always indicated), tier 2 (may be indicated), and tier 3 (rarely indicated). Providers received education on appropriate RTD prescribing followed by monthly peer comparison feedback on antibiotic prescribing for (1) all tiers and (2) tier 3 RTDs. A χ 2 test was used to compare the proportion of visits with antibiotic prescriptions before and during the intervention. Mixed-effects multivariable logistic regression analysis was performed to assess the association between the intervention and antibiotic prescribing.
resultsAcross 30 PC practices and 185 755 total visits, overall antibiotic prescribing was reduced with the intervention, from 35.2% to 23.0% of visits (P < .001). In multivariable analysis, the intervention was associated with a reduced odds of antibiotic prescription for tiers 2 (odds ratio [OR] 0.57; 95% confidence interval [CI] .52-.62) and 3 (OR 0.57; 95% CI .53-.61) but not for tier 1 (OR 0.98; 95% CI .83-1.16).
conclusionsA provider-focused intervention reduced overall antibiotic prescribing for RTDs without affecting prescribing for infections that likely require antibiotics. Future research should examine the sustainability of such interventions, potential unintended adverse effects on patient health or satisfaction, and provider perceptions and acceptability.
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