Controlled trials to improve antibiotic utilization: a systematic review of experience, 1984-2004.
OBJECTIVE
To review the effectiveness of interventions designed to improve antibiotic prescribing patterns in clinical practice and to draw inferences about the most practical methods for optimizing antibiotic utilization in hospital and ambulatory settings.


METHODS
A literature search using online databases for the years 1975-2004 identified controlled trials of strategies for improving antibiotic utilization. Due to variation in study settings and design, quantitative meta-analysis was not feasible. Therefore, a qualitative literature review was conducted.


RESULTS
Forty-one controlled trials met the search criteria. Interventions consisted of education, peer review and feedback, physician participation, rewards and penalties, administrative methods, and combined approaches. Social marketing directed at patients and prescribers was effective in varying contexts, as was implementation of practice guidelines. Authorization systems with structured order entry, formulary restriction, and mandatory consultation were also effective. Peer review and feedback were more effective when combined with dissemination of relevant information or social marketing than when used alone.


CONCLUSIONS
Several practices were effective in improving antibiotic utilization: social marketing, practice guidelines, authorization systems, and peer review and feedback. Online systems providing clinical information, structured order entry, and decision support may be the most promising approach. Further studies, including economic analyses, are needed to confirm or refute this hypothesis.
Parrino
Thomas A
TA
West Palm Beach Veterans Affairs Medical Center, West Palm Beach, Florida 33410, USA. thomas.parrino@med.va.gov
D020000:Decision Support Systems, Clinical; D004358:Drug Therapy / Q000191:economics*; D017723:Drug Utilization Review / Q000379:methods*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic