Internet-Based Training Program can Trigger a Two-Thirds Drop in Antibiotic Prescription Rates

Paul Little, Professor of Primary Care Research at the University of Southampton, comments: "The high volume of prescribing antibiotics in primary care is a major driver of antibiotic resistance, which is one of the great public health dangers of our time, and raises the real prospect of serious infections becoming untreatable.

"Training has been shown to have a positive effect on lowering prescription rates but the way training has been delivered and its reliance on highly trained staff around centres of excellence severely limits the impact in everyday practice. Novel techniques are therefore needed to lead changes at a national and international level. Internet training has the advantage that it can be disseminated widely at a low cost and does not need much resource."

Lower respiratory tract infections (LRTI), such as chest infections like bronchitis, are one of the most common acute illnesses treated in primary care in developed countries. Although viruses are believed to cause most of these infections, there is still debate about whether or not antibiotics are beneficial for some patients in the treatment of LRTI, particularly in older patients. Meanwhile antibiotics are still being prescribed in high amounts, fuelling antibiotic resistance.

In the study, from the GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium and funded by the European Community's Sixth Framework Programme, 246 clinical practices from six countries were recruited. They were randomised to one of four trial arms: usual care, internet-based training to use a C-reactive protein (CRP) test (an indicator test for pneumonia), internet-based training in enhanced communication skills, and combined training in both CRP and enhanced communication.

The study, supported by the National Institute for Health Research Clinical Research Network in England, showed that clinicians who received training in using the CRP test or the enhanced communications skills training significantly reduced their antibiotic prescribing rates for LRTI, compared to usual care (47 per cent and 32 per cent respectively). Furthermore, clinicians who received training in a combination of both reduced prescribing antibiotics by 62 per cent.

Additionally prescribing rates also fell for upper respiratory tract infections (e.g. colds, influenza, and throat, ear and sinus infections). These infections were not targeted by the intervention, which suggests that further modifications could be made to the internet training to better address these conditions, which would maximise the impact of training.

Professor Little adds: "These interventions have shown that providing interactive training methods using the internet to modify antibiotic prescribing is remarkably effective. Moreover the internet-based training programmes are transferrable between very different primary care settings."

Source-Eurekalert

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Scientists Find New Way to Improve Antibiotic Production

Scientists Dr Emma Sherwood and Professor Mervyn Bibb from the John Innes Centre were able to use their discovery of how the antibiotic is naturally produced to markedly increase the level of production.

"We have shown for the first time that an antibiotic with clinical potential can act as signalling molecule to trigger its own synthesis," said Professor Bibb.

The antibiotic called planosporicin is produced by a soil bacterium called Planomonospora alba. When nutrients become limited, a small amount of the antibiotic is produced. The antibiotic is then able to trigger a mechanism which coordinates its own production throughout the bacterial population resulting in high levels.

"A frequent stumbling block in developing a natural product for commercialisation is being able to provide enough material for clinical trials," said Professor Bibb.

"Our work shows with the right understanding it is possible to increase productivity very dramatically in a targeted and knowledge-based manner."

With knowledge of this signalling mechanism in hand, the scientists were able to increase production by overexpressing two positively acting regulatory genes and deleting one that acts negatively. Planosporicin is similar to the antibiotic NAI-107 that is about to enter clinical trials for Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) infections. The knowledge gained from this study is being used to increase NAI-107 production.

Commercial manufacturers of antibiotics may be able to use the results to reduce production times and therefore reduce costs. Bacteria often have to be grown for days and sometimes weeks before they start to make effective amounts of an antibiotic. Sherwood and Bibb were able to trigger production essentially from the beginning of growth.

Source-Eurekalert

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Intervention Improves Adherence to Antibiotic Prescribing Guidelines for Children: Study

by Rukmani Krishna on? June 15, 2013 at 12:30 AM Child Health News According to a study in the June 12 issue of JAMA, an intervention consisting of clinician education coupled with personalized audit and feedback about antibiotic prescribing improved adherence to prescribing guidelines for common pediatric bacterial acute respiratory tract infections, although the intervention did not affect antibiotic prescribing for viral infections.
"Antibiotics are the most common prescription drugs given to children. Although hospitalized children frequently receive antibiotics, the vast majority of antibiotic use occurs in the outpatient setting, roughly 75 percent of which is for acute respiratory tract infections (ARTIs). Unnecessary prescribing for viral ARTIs is well documented and has been declining. However, inappropriate prescribing also occurs for bacterial ARTIs, particularly when broad-spectrum antibiotics are used to treat infections for which narrow-spectrum antibiotics are indicated and recommended," according to background information in the article. "Antimicrobial stewardship programs have been effective for inpatients, often through prescribing audit and feedback. However, most antimicrobial use occurs in outpatients with acute respiratory tract infections.

Jeffrey S. Gerber, M.D., Ph.D., of The Children''s Hospital of Philadelphia, and colleagues conducted a study to evaluate the effect of an antimicrobial stewardship intervention on antibiotic prescribing for pediatric outpatients. The randomized trial of outpatient antimicrobial stewardship compared prescribing between intervention and control practices using a common electronic health record. After excluding children with chronic medical conditions, antibiotic allergies, and prior antibiotic use, the researchers estimated prescribing rates for targeted ARTIs standardized for age, sex, race, and insurance from 20 months before the intervention to 12 months afterward (October 2008-June 2011). The study included a network of 18 pediatric primary care practices in Pennsylvania and New Jersey (162 clinicians). Overall, there were 1,291,824 office visits by 185,212 unique patients.

The intervention consisted of one 1-hour on-site clinician education session followed by 1 year of personalized, quarterly audit and feedback of prescribing for bacterial and viral ARTIs or usual practice. The researchers measured rates of broad-spectrum (off-guideline) antibiotic prescribing for bacterial ARTIs and antibiotics for viral ARTIs for 1 year after the intervention.

The authors found that among children who were prescribed antibiotics for any indication, the overall proportion of antibiotic prescriptions that were broad-spectrum decreased from 26.8 percent to 14.3 percent in the intervention group and from 28.4 percent to 22.6 percent in control practices (difference of differences [DOD], 6.7 percent) during the 12-months following initiation of education/audit and feedback.

"When stratifying by the individual bacterial ARTIs targeted by the intervention, broad-spectrum (off-guideline) antibiotic prescribing for pneumonia decreased from 15.7 percent to 4.2 percent in the intervention group and from 17.1 percent to 16.3 percent in the control group (DOD, 10.7 percent). Broad-spectrum prescribing for acute sinusitis decreased from 38.9 percent to 18.8 percent in the intervention group and from 40.0 percent to 33.9 percent in the control practices (DOD, 14.0 percent). Broad-spectrum prescribing for streptococcal pharyngitis started and remained low for both the intervention group (from 4.4 percent to 3.4 percent) and the control group (from 5.6 percent to 3.5 percent) (DOD, -1.1 percent)," they write.

In addition, the baseline rate of any antibiotic prescribing for viral infections was low and did not change significantly after the intervention in either the intervention group (from 7.9 percent to 7.7 percent) or the control group (from 6.4 percent to 4.5 percent) (DOD, -1.7 percent).

"This intervention nearly halved prescribing of broad-spectrum antibiotics to children during acute primary care encounters and decreased use of off-guideline antibiotics for children with pneumonia by 75 percent by 1 year after the intervention," the researchers note.

"Our findings suggest that extending antimicrobial stewardship to the ambulatory setting, where such programs have generally not been implemented, may have important health benefits."

"This targeted application of antimicrobial stewardship principles to the ambulatory setting has the potential to affect the most common indications for antibiotic use. Future studies should examine the key drivers of these effects on antibiotic prescribing and the generalizability of findings to other health systems and measure the sustainability and clinical outcomes associated with differential prescribing patterns," the authors conclude.

Source-Newswise

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