Opinion statement
Educational interventions to improve prescriber and patient knowledge of appropriate antibiotic use are a key component of successful antimicrobial stewardship campaigns in diverse healthcare settings. Provider education may be an impactful strategy for reducing unnecessary prescribing of antibiotics for respiratory tract infections and asymptomatic bacteriuria. Educational interventions designed to improve adherence to prescribing guidelines are more consistently able to impact prescribing of a specific class of medications (e.g., third generation cephalosporins, fluoroquinolones) than overall adherence to a set of specific treatment recommendations. Further research is needed to assess the independent impact of educational programs in bundled stewardship efforts and the duration of their effect on prescribing. Facilitating evidence-based discussions on antimicrobial use between patients and providers has been shown to reduce inappropriate prescribing. However, the impact of these programs on other important metrics in primary care, including duration of physician-patient time, wait times, and number of return office visits, has not been addressed. Educational campaigns in non-clinical settings may be effective ways to educate adults and children on principles of antimicrobial stewardship. Future studies should examine the impact of education outside of the physician’s office on future patient behavior.
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Lee CR, Lee JH, Kang LW, Jeong BC, Lee SH. Educational effectiveness, target, and content for prudent antibiotic use. Biomed Res Int. 2015;214021:1–13. doi:10.1155/2015/214021 This article is a review of recent studies on the effect of interventions for advocating prudent antibiotic prescribing. This article highlights educational strategies targeted to medical professionals as well as the general public, including both adult and pediatric patients.
Ohl CA, Luther VP. Health care provider education as a tool to enhance antibiotic stewardship practices. Infect Dis Clin N Am. 2014;28:177–93. Antibiotic stewardship education should have a broad content and begin early and often during the education of health care providers. Active education techniques have proven to be the most effective for changing prescribing behaviors.
Morrill HJ, Caffrey AR, Jump RL, Dosa D, LaPlante KL. Antimicrobial stewardship in gong-term care facilities: a call to action. J Am Med Dir Assoc. 2016;17:183.e1–e16.
Wang S, Pulcini C, Rabaud C, Boivin JM, Birgé J. Inventory of antibiotic stewardship programs in general practice in France and abroad. Med Mal Infect. 2015;45:111–23.
Kullar R, Goff DA. Transformation of antimicrobial stewardship programs through technology and informatics. Infect Dis Clin N Am. 2014;28:291–300.
Pulcini C, Gyssens IC. How to educate prescribers in antimicrobial stewardship practices. Virulence. 2013;4:192–202. Covers how to educate prescribers in regards to antimicrobial stewardship practices.
Avent ML, Hall L, Davis L, Allen M, et al. Antimicrobial stewardship activities: a survey of Queensland hospitals. Aust Health Rev. 2014;38:557–63.
Weston A, Epstein L, Davidson LE, Demaria A, Doron S. The impact of a Massachusetts state sponsored educational program on antimicrobial stewardship in acute care hospitals. Infect Control Hosp Epidemiol. 2013;34:437–9.
Kram JJF, Borlaug G, Safdar N, Sethi A. Development and distribution of educational materials for carbapenem-resistant Enterobacteriaceae among acute and long-term care facilities. WMJ. 2015;114:48–51.
Dyar OJ, Pulcini C, Howard P, et al. European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother. 2014;69:842–6.
Abbo LM, Cosgrove SE, Pottinger PS, et al. Medical students’ perceptions and knowledge about antimicrobial stewardship: how are we educating our future prescribers? Clin Infect Dis. 2013;57:631–8.
Desear KE, Borgert S, Leclaire AC, Klinker K, Weitzel K, et al. Evaluation of an interactive educational model to enhance antimicrobial stewardship at an Academic Medical Center. J Pharm Care Health Sys. 2015: S2001. doi:10.4172/jpchs.1000-S2-001
Bryant PA. Antimicrobial stewardship resources and activities for children in tertiary hospitals in Australasia: a comprehensive survey. Med J Aust. 2015;202:134–8.
Arroll B. Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews. Respir Med. 2005;99:255–61.
Little P, Stuart B, Francis N, et al. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet. 2013;382:1175–82.
Hingorani R, Mahmood M, Alweis R. Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process. J Community Hosp Intern Med Perspect. 2015;5:27472.
Zimmerman S, Sloane PD, Bertrand R, et al. Successfully reducing antibiotic prescribing in nursing homes. J Am Geriatr Soc. 2014;62:907–12.
Le Corvoisier P, Renard V, Roudot-Thoraval F, et al. Long-term effects of an educational seminar on antibiotic prescribing by GPs: a randomised controlled trial. Br J Gen Pract. 2013;63:e445–64.
Ferrat E, Le Breton J, Guéry E, et al. Effects 4.5 years after an interactive GP educational seminar on antibiotic therapy for respiratory tract infections: a randomized controlled trial. Fam Pract. 2016: 1–8.
Gerber JS, Prasad PA, Fiks AG, et al. Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback. JAMA. 2014;17:2569–70.
Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40:643–54.
Irfan N, Brooks A, Mithoowani S, et al. A controlled quasi-experimental study of an educational intervention to reduce the unnecessary use of antimicrobials for asymptomatic bacteriuria. PLoS One. 2015;10:e0132071. doi:10.1371/journal.pone.0132071.
Kelley D, Aaronson P, Poon E, et al. Evaluation of an antimicrobial stewardship approach to minimize overuse of antibiotics in patients with asymptomatic bacteriuria. Infect Control Hosp Epidemiol. 2014;35:193–5.
Hulscher ME, Grol RP, van der Meer JW. Antibiotic prescribing in hospitals: a social and behavioural scientific approach. Lancet Infect Dis. 2010;10:167–75.
Nagdeo N, Sonarkar R, Thombare VR, Akhtar M, Dasgupta S. Effects of an educational module in rationalizing surgical prophylaxis. Indian J Surg. 2015;77:290–6.
Saied T, Hafez S, Kandeel A, et al. Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: a multicenter pilot intervention study. Am J Infect Control. 2015;43:e67–71.
Velez RP, Becker KL, Davidson P, Sloand E. A quality improvement intervention to address provider behaviour as it relates to utilisation of CA-MRSA guidelines. J Clin Nurs. 2015;24:556–62.
Schuler CL, Courter JD, Conneely SE, et al. Decreasing duration of antibiotic prescribing for uncomplicated skin and soft tissue infections. Pediatrics. 2016;137:1–7.
Popovski Z, Mercuri M, Main C, et al. Multifaceted intervention to optimize antibiotic use for intra-abdominal infections. J Antimicrob Chemother. 2015;70:1226–9.
Liang B, Blanchette LM, Wheeler JS. Impact of combination antibiogram and related education on inpatient fluoroquinolone prescribing patterns for patients with health care–associated pneumonia. Ann Pharmacother. 2016;50:172–9.
Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:103–20.
Percival KM, Valenti KM, Schmittling SE, et al. Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED. Am J Emerg Med. 2015;33:1129–33.
Gillespie E, Rodrigues A, Wright L, Williams N, Stuart RL. Improving antibiotic stewardship by involving nurses. Am Infect Control. 2013;41:365–7.
Crader MF. Development of antimicrobial competencies and training for staff hospital pharmacists. Hosp Pharm. 2014;49:32–40.
Smith P, Mcquattie K. Reducing antibiotic prescribing for self-limiting respiratory tract infections in primary care: a pilot study. Self Care. 2014;5:110–4.
Francis NA, Butler CC, Hood K, Simpson S, Wood F, Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. BMJ. 2009;339:b2885. doi:10.1136/bmj.b2885.
Francis NA, Phillips R, Wood F, Hood K, Simpson S, Butler CC. Parents’ and clinicians’ views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial. BMC Fam Pract. 2013;14:182. doi:10.1186/1471-2296-14-182.
Lecky DM, Hawking MKD, Verlander NQ, McNulty CAM. Using interactive family science shows to improve public knowledge on antibiotic resistance: does it work? PLoS One. 2014;9:e104556. doi:10.1371/journal.pone.0104556. eCollection 2014.
Shehadeh MB, Suaifan GARY, Hammad EA. Active educational intervention as a tool to improve safe and appropriate use of antibiotics. Saudi Pharm J. 2015. doi:10.1016/j.jsps.2015.03.025.
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Drs Gravatt, Patterson and Franzese declare no conflict of interest.
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Gravatt, L.A.H., Patterson, J.A. & Franzese, S. Educational Antimicrobial Stewardship Strategies. Curr Treat Options Infect Dis 8, 84–92 (2016). https://doi.org/10.1007/s40506-016-0073-9
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DOI: https://doi.org/10.1007/s40506-016-0073-9