title: Educational interventions to improve prescription and dispensing of antibiotics: a systematic review.
abstract: BACKGROUND
  Excessive and inappropriate antibiotic use contributes to growing antibiotic resistance, an important public-health problem. Strategies must be developed to improve antibiotic-prescribing. Our purpose is to review of educational programs aimed at improving antibiotic-prescribing by physicians and/or antibiotic-dispensing by pharmacists, in both primary-care and hospital settings.
  
  
  METHODS
  We conducted a critical systematic search and review of the relevant literature on educational programs aimed at improving antibiotic prescribing and dispensing practice in primary-care and hospital settings, published in January 2001 through December 2011.
  
  
  RESULTS
  We identified 78 studies for analysis, 47 in primary-care and 31 in hospital settings. The studies differed widely in design but mostly reported positive results. Outcomes measured in the reviewed studies were adherence to guidelines, total of antibiotics prescribed, or both, attitudes and behavior related to antibiotic prescribing and quality of pharmacy practice related to antibiotics. Twenty-nine studies (62%) in primary care and twenty-four (78%) in hospital setting reported positive results for all measured outcomes; fourteen studies (30%) in primary care and six (20%) in hospital setting reported positive results for some outcomes and results that were not statistically influenced by the intervention for others; only four studies in primary care and one study in hospital setting failed to report significant post-intervention improvements for all outcomes. Improvement in adherence to guidelines and decrease of total of antibiotics prescribed, after educational interventions, were observed, respectively, in 46% and 41% of all the reviewed studies. Changes in behaviour related to antibiotic-prescribing and improvement in quality of pharmacy practice was observed, respectively, in four studies and one study respectively.
  
  
  CONCLUSIONS
  The results show that antibiotic use could be improved by educational interventions, being mostly used multifaceted interventions.
authors.forename: Fátima
authors.initials: F
authors.lastname: Roque
authors.affiliation: Centre for Cell Biology, University of Aveiro (Centro de Biologia Celular - CBC/UA); Campus Universitário de Santiago, 3810-193 Aveiro, Portugal. teresaherdeiro@ua.pt.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Herdeiro
authors.forename: Sara
authors.initials: S
authors.lastname: Soares
authors.forename: António
authors.initials: A
authors.lastname: Teixeira Rodrigues
authors.forename: Luiza
authors.initials: L
authors.lastname: Breitenfeld
authors.forename: Adolfo
authors.initials: A
authors.lastname: Figueiras
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004502:Education, Medical, Continuing / Q000379:methods*; D004513:Education, Pharmacy, Continuing; D006761:Hospitals; D006801:Humans; D010595:Pharmacists; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care; D058996:Quality Improvement
chemical_list: D000900:Anti-Bacterial Agents