title: Changing antibiotics prescribing practices in health centers of Khartoum State, Sudan.
abstract: OBJECTIVE
  A major problem with inappropriate use of antibiotics is the emergence of resistance. Thus, cost-effective interventional strategies are required to improve their use. This study aimed to evaluate the effect of multifaceted interventions on prescribing practices of antibiotics in health centers of Khartoum State, Sudan.
  
  
  METHODS
  Twenty health centers were randomly assigned to receive: (1) no intervention; (2) audit and feedback; (3) audit and feedback + seminar; or (4) audit and feedback + academic detailing. A total of 1,800 patient encounters, 30 from each health center, were randomly collected. The total number of encounters with antibiotics prescribed were determined in each health center and they were evaluated with regard to antibiotic choice, dose and duration of therapy before the study and at 1 and 3 months post-intervention.
  
  
  RESULTS
  In comparison to the control group, the prescriber targeted interventions involving audit and feedback, together with academic detailing (4), reduced the mean number of encounters with an antibiotic prescribed by 6.3 and 7.7 (p<0.001) at 1 and 3 months post-intervention, respectively. In addition, the mean number of encounters with an inappropriate antibiotic with respect to diagnosis, doses and/ or duration of therapy was reduced by 5.3 and 5.9 (p<0.001) at 1 and 3 months post-intervention, respectively. For audit and feedback together with seminars (3) and for audit and feedback alone (2), the corresponding reductions were 5.3, 7.1, 4.4 and 5.1 (p<0.001) and 1.4, 2.8, 1.8 and 1.9 (p>0.05), respectively.
  
  
  CONCLUSIONS
  Inappropriate prescribing patterns of antibiotics in health centers of Khartoum State, Sudan, are alarmingly high. Multifaceted interventions involving audit and feedback combined with either academic detailing or seminars appear more effective in changing prescribing practices of antibiotics than audit and feedback alone.
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait, Kuwait. amoneim@hsc.edu.kw
authors.forename: A I
authors.initials: AI
authors.lastname: Awad
authors.forename: I B
authors.initials: IB
authors.lastname: Eltayeb
authors.forename: O Z
authors.initials: OZ
authors.lastname: Baraka
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial; D004502:Education, Medical, Continuing / Q000379:methods; D005246:Feedback; D006801:Humans; D008485:Medical Audit; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care / Q000458:organization & administration; D013397:Sudan
chemical_list: D000900:Anti-Bacterial Agents