A randomized controlled trial to change antibiotic prescribing patterns in a community

Background: Excessive and inappropriate use of antibiotics has been identified as a leading cause of the emergence of multiply resistant strains of pneumococci. Objective: To examine the effects of academic detailing and a parental education program on community pediatricians' prescription of antibiotics for young children. Methods: Physician leaders in study practices prepared educational modules and presented the modules to their practices. The control groups received only practice-specific report cards. Using a time-series analysis, we collected data on office visits and antibiotic prescriptions filled between May 1, 2000, and April 30, 2001 (baseline period), and between May 1, 2001, and April 30, 2002 (intervention period). Antibiotic prescription rate was defined as the ratio of antibiotic prescriptions filled to the number of office visits. Results: The antibiotic prescription rate decreased to 0.82 (95% confidence interval, 0.71-0.95) of the baseline rate for the study group (6 practices) and to 0.86 (95% confidence interval, 0.77-0.95) of the baseline for the control group (5 practices). Similar patterns for antibiotic prescription rates were seen for study and control groups both before and after the intervention. Wide variations in prescription rates were observed among the practices, but, in general, the control practices had lower antibiotic prescribing rates during both the baseline and the intervention periods. Use of amoxicillin increased slightly in the study group and decreased slightly in the control group. The use of cephalosporins increased slightly in both groups. Conclusion: Overall, academic detailing appeared to be no more effective in reducing antibiotic use than the practice-specific report cards alone.