title: Decreasing antibiotic use through a joint intervention targeting physicians and pharmacists.
abstract: OBJECTIVE
  To decrease population antibiotic use through an educational intervention targeting primary care physicians' and community pharmacists' attitudes and knowledge.
  
  
  METHODS
  We designed a pragmatic cluster-randomized trial covering all National Health System primary care physicians and all community pharmacists' in a region in the north of Portugal. The study protocol was registered on ClinicalTrials.gov (identifier: NCT02173509).
  
  
  RESULTS
  After adjustment for baseline values and comparison with the control group, the intervention was associated with a significant reduction in overall antibiotic use in the year following the intervention. The effect was most marked for tetracyclines, macrolides and cephalosporins. No statistically significant differences were observed for fluoroquinolone consumption.
  
  
  CONCLUSIONS
  Multifaceted interventions involving physicians, pharmacists and general public proved effective in reducing antibiotic consumption in the population.
authors.affiliation: Department of Medical Sciences & Institute for Biomedicine - iBiMED, University of Aveiro, 3810-193 Aveiro, Portugal.|Health Sciences Research Centre, University of Beira Interior (Centro de Investigação em Ciências da Saúde - CICS/UBI), 6200-506 Covilhã, Portugal.|Research Unit for Inland Development, Polytechnic of Guarda (Unidade de Investigação para o Desenvolvimento do Interior - UDI/IPG), 6300-559 Guarda, Portugal.
authors.forename: Fátima
authors.initials: F
authors.lastname: Roque
authors.affiliation: Department of Medical Sciences & Institute for Biomedicine - iBiMED, University of Aveiro, 3810-193 Aveiro, Portugal.|Faculty of Pharmacy, University of Coimbra (Faculdade de Farmácia da Universidade de Coimbra - FFUC), 3000-548 Coimbra, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Teixeira-Rodrigues
authors.affiliation: Health Sciences Research Centre, University of Beira Interior (Centro de Investigação em Ciências da Saúde - CICS/UBI), 6200-506 Covilhã, Portugal.
authors.forename: Luiza
authors.initials: L
authors.lastname: Breitenfeld
authors.affiliation: Consortium for Biomedical Research in Epidemiology & Public Health (CIBER enEpidemiología y Salud Pública - CIBERESP), Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Piñeiro-Lamas
authors.affiliation: Consortium for Biomedical Research in Epidemiology & Public Health (CIBER enEpidemiología y Salud Pública - CIBERESP), Spain.|Department of Preventive Medicine & Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Figueiras
authors.affiliation: Department of Medical Sciences & Institute for Biomedicine - iBiMED, University of Aveiro, 3810-193 Aveiro, Portugal.|Higher Polytechnic & University Education Co-operative (Cooperativa de Ensino Superior Politécnico e Universitário - CESPU), Institute for Advanced Research & Training in Health Sciences & Technologies, 4585-116 Gandra, Portugal.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Herdeiro
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004501:Education, Medical / Q000379:methods; D004512:Education, Pharmacy / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018942:Macrolides / Q000008:administration & dosage / Q000009:adverse effects; D010595:Pharmacists; D010820:Physicians; D011174:Portugal; D010818:Practice Patterns, Physicians'; D000067490:Prescription Drug Overuse / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D013754:Tetracyclines / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D013754:Tetracyclines
keywords: antibiotic consumption; antibiotic policies; community pharmacists; educational interventions; microbial resistance; primary care physicians