European Journal of Clinical Pharmacology

, Volume 70, Issue 8, pp 1011–1020 | Cite as

Improving the appropriateness of antimicrobial use in primary care after implementation of a local antimicrobial guide in both levels of care

  • Rocío Fernández UrrusunoEmail author
  • Macarena Flores Dorado
  • Angel Vilches Arenas
  • Carmen Serrano Martino
  • Susana Corral Baena
  • Ma Carmen Montero Balosa
Pharmacoepidemiology and Prescription



This study aims to assess the effectiveness of multiple interventions carried out during the implementation of a guide, on the improvement of the appropriateness of antimicrobial prescribing in primary care.


This is a cross-sectional before/after study carried out in Aljarafe Health Care Area (Andalusia, Spain), with a population of 368,728 inhabitants assisted in 37 health centers.


Subjects include patients with antibiotic prescriptions during 2009 (pre-intervention phase) or 2012 (postintervention phase) selected by simple random sampling (confidence level, 95 %; accuracy, 5 %), with infections registered in the electronic clinical history.


This study involve training sessions in primary care centers and hospital services, incorporation of the electronic guide to the Health Care Service Websites, and incorporation of the guide to the Digital Health History as a tool to support decision making.

Main outcome

Difference on appropriate antibiotic prescribing before and after interventions resulted from the study. Other variables also include age, gender, type of pharmacy, antibiotic prescribed, number of treatments per year, infection site, and main comorbidities


In addition, this study uses computerized pharmacy records of reimbursed and dispensed drugs and electronic medical histories.


The percentage of appropriate antibiotic prescribing increased from 36 % in 2009 to 57 % in 2012 (p < 0.001) is shown. The improvement was observed in all age patients of any sex and was higher among working-age patients and patients with comorbidities. The best results were observed in the group of beta-lactams and in the treatment of respiratory and skin infections.


The realization of multifactorial interventions involving professionals from both levels of care could be an effective strategy to improve the use of antimicrobials in primary care.


Appropriate prescription Antibiotics Infections Multifaceted interventions Primary care 



This work has received an award from the Spanish Society of Primary Care Pharmacy (SEFAP), sponsored by Chiesi: Research Award for Pharmaceutical Primary Care 2013. The authors wish to thank the people who have also participated in the implementation of the guide: M.T. Alonso Salas (specialist in Pediatry, Section Chief of Pediatric Emergencies, Hospital Virgen del Rocío), C. Bravo Escudero (Dentist, Distrito Sanitario Aljarafe), M. Chávez Caballero (specialist in Clinical Microbiology and Parasitology, Hospital San Juan de Dios del Aljarafe), R. Espinosa Calleja (specialist in Internal Medicine, Hospital San Juan de Dios del Aljarafe), A. Fernández Moyano (specialist in Internal Medicine, Chief Medical Service, Hospital San Juan de Dios del Aljarafe), M.J. Garabito Sánchez (specialist in Hospital Pharmacy, Chief Pharmacy Service, Hospital San Juan de Dios del Aljarafe), M. Martínez Granero (specialist in Family and Community Medicine, Distrito Sanitario Aljarafe), M. Olivencia Pérez (specialist in Otolaryngology, Chief Otolaryngology Service, Hospital San Juan de Dios del Aljarafe), M. Ramírez Arcos (specialist in Clinical Microbiology and Parasitology, Hospital San Juan de Dios del Aljarafe), M. Remírez de Esparza Otero (specialist in Hospital Pharmacy, Hospital San Juan de Dios del Aljarafe), V. Rodríguez Pappalardo (specialist in Family and Community Medicine, Distrito Sanitario Aljarafe), S. Taboada Prieto (specialist in Family and Community Medicine, Emergencies Service, Hospital San Juan de Dios del Aljarafe), and A. Vázquez Florido (specialist in Pediatry, Pediatric Emergencies Section, Hospital Virgen del Rocío).


This investigation was financially supported by two research projects: FISS Spanish Ministry of Health (project PI/10/01152) and Andalusian Regional Ministry of Health (project PI-0160-2010).

Conflict of interest

The authors declare that they have not conflicts of interest to disclose.

Ethics approval

This study has been approved by the Ethics Committee on Health Research of the Hospital Virgen del Rocío (Seville, Spain). This work complies with the current laws of the country in which it was performed.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Rocío Fernández Urrusuno
    • 1
    Email author
  • Macarena Flores Dorado
    • 1
  • Angel Vilches Arenas
    • 2
    • 3
  • Carmen Serrano Martino
    • 4
  • Susana Corral Baena
    • 5
  • Ma Carmen Montero Balosa
    • 1
  1. 1.Service of PharmacyAljarafe-Sevilla Norte Primary Health Care AreaSevilleSpain
  2. 2.Service of EpidemiologySevilla Primary Health Care AreaSevilleSpain
  3. 3.Departamento de Medicina Preventiva y Salud PúblicaUniversidad de SevillaSevilleSpain
  4. 4.Service of MicrobiologySan Juan de Dios HospitalSevilleSpain
  5. 5.Service of PharmacySan Juan de Dios HospitalSevilleSpain

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