title: Improvements in antimicrobial prescribing for treatment of upper respiratory tract infections through provider education.
abstract: BACKGROUND
  Inappropriate use of antimicrobials to treat acute upper respiratory tract infections (URIs), which usually have a viral etiology, contributes to emergence and spread of antimicrobial resistance in Streptococcus pneumoniae and other human bacterial pathogens.
  
  
  OBJECTIVE
  To reduce antimicrobial use for management of acute URIs in adult and pediatric patients.
  
  
  METHODS
  Prospective, nonrandomized, controlled trial.
  
  
  METHODS
  Four primary care clinics within a staff model HMO in Detroit, Mich.
  
  
  METHODS
  Twenty-one primary care physicians at clinics where the educational intervention was implemented, and 9 primary care physicians at control clinics where no educational programs were implemented.
  
  
  METHODS
  Antibiotic prescribing for acute URIs during the baseline and study years among the intervention and control groups.
  
  
  RESULTS
  A generalized linear mixed-effects model was used and showed that antimicrobial prescribing among the intervention group physicians decreased 24.6% from the baseline to the postintervention period (P<.0001) for both pediatric and adult medicine physicians. From the baseline to the study period, there was no significant decline in rates of antimicrobial prescribing by the control group of physicians (pediatricians, P=.35; internists, P=.42). The rates of decline in antimicrobial prescribing differed significantly between the intervention and control groups (P<.0003 for pediatricians and P<.01 for Internists).
  
  
  CONCLUSIONS
  An interactive, case-based educational program for physicians and their staff proved effective for reducing unwarranted prescribing of antibiotics in the treatment of URIs by primary care physicians in a Medicaid HMO setting.
authors.affiliation: Michigan Public Health Institute, Okemos, MI 48009, USA. njuzych@wayne.edu
authors.forename: Nadia Shalauta
authors.initials: NS
authors.lastname: Juzych
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Lynette
authors.initials: L
authors.lastname: Essenmacher
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Lerner
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004502:Education, Medical, Continuing; D006801:Humans; D010821:Physicians, Family / Q000193:education*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents