Research in Action: Addressing Antibiotic Overprescribing

Antimicrobial resistance is a rising global public health crisis with an estimated 1.27 million attributable deaths per year worldwide. Overprescribing antibiotics in primary care has been a significant issue, often leading to increased rates of drug-resistant infections and avoidable side effects for patients. A new study, co-authored by Public Health Ontario (PHO) researchers, Drs. Kevin Schwartz, Kevin Brown, and Nick Daneman, as well as Bradley Langford, Valerie Leung, and Lindsay Friedman, aimed to address this problem by sending feedback letters to over 5,000 family doctors, resulting in a notable reduction in antibiotic prescribing. Here’s a detailed look into the study’s findings and its implications for public health.

Why is the study important?
Antibiotics are frequently overprescribed, often for viral infections that don’t respond to such treatment. This practice not only exposes patients to unnecessary side effects, but also contributes to the rise of drug-resistant infections. This study demonstrates a practical approach to curbing antibiotic overuse, potentially improving patient outcomes and slowing the spread of resistance.

Key findings
The study’s researchers randomly divided over 5,000 family doctors into different groups to test different feedback interventions; some of the doctors were sent mailed letter with antibiotic prescribing feedback and some were not. The results were significant, compared to no mailed feedback, mailed feedback was associated with:

• A five per cent overall reduction in antibiotic prescribing.
• An 11 per cent reduction in unnecessary prescribing.
• A 15 per cent reduction in prolonged antibiotic prescription durations.

Changes in physician prescribing approaches
The study’s feedback letters effectively influenced physician behavior. The observed reductions in prescribing diminished over time, indicating the need for regular feedback.

Reactions among physicians
The authors collaborated with family doctors to develop the letters and ensure the data was offered in a supportive manner, in order to support quality improvement for patient care. Most doctors responded positively to the feedback, and demonstrated an interest in reviewing how their prescribing data compared to other peers, and welcomed the opportunity to identify potential areas for improvement. However, a significant challenge was getting doctors to engage with the letters—only about 1 in 6 opened and read the feedback.

Future directions
The study revealed a need to increase engagement with feedback reports, as a critical area for future research. Family doctors face numerous demands, and finding ways to make feedback more accessible and impactful is essential for ongoing improvements in antibiotic prescribing.

Public health implications
Antimicrobial resistance is a global problem with different drivers depending on the country and setting. In Canada, we know that overprescribing of antibiotics is one of the most important contributors fueling antimicrobial resistance. The small reductions in antibiotic use achieved through this study, can have important long term public health impacts by reducing antimicrobial resistance. Further actions are needed both locally and globally to support the judicious use of antimicrobials and help combat rising drug resistant infections. PHO promotes and supports antimicrobial stewardship to improve and optimize antimicrobial therapy and clinical outcomes for patients in primary care. Visit, PHO’s Antimicrobial Stewardship in Primary Care webpage.