Education and feedback improve antibiotic prescribingfor childrenJAMA 2013;309:2345-52Researchers from the US have designed and tested a way todiscourage primary care doctors from prescribing broadspectrum antibiotics to children with respiratory infections. Asingle hour of education followed by audit and regular,confidential, and automated feedback reduced inappropriateprescribing by an absolute 6.7% in a cluster randomised trial.Doctors in control practices had no education or feedback, butthey did know their prescribing was being tracked. Prescriptionsof broad spectrum antibiotics for selected infections fell from26.8% to 14.3% in intervention practices and from 28.4% to22.6% in control practices (P=0.01).The trial lasted a year and looked at prescribing for childrenwith sinusitis, pneumonia, and streptococcal pharyngitis. Doctorsin intervention practices were advised to start with amoxicillin

or penicillin, in accordance with US guidelines. Prescribingimproved steadily during the year and improved most forchildren with pneumonia. Antibiotic prescribing for viralinfections was uncommon to start with and changed little ineither group of practices.All participating paediatricians worked in one of 18 primarycare practices with a shared electronic health record and linksto local hospitals. Researchers had to exclude prescribing forotitis media—the most common reason for antibioticprescription in children—because some practices in the networkintroduced a decision tool during the trial.

Cite this as: BMJ 2013;346:f3794© BMJ Publishing Group Ltd 2013

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BMJ 2013;346:f3794 doi: 10.1136/bmj.f3794 (Published 12 June 2013) Page 1 of 1

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