Continuing Medical Education Courses Decreased Antibiotic Use in Italy

Inappropriate and unnecessary antibiotic prescribing has contributed greatly to a worldwide problem of antimicrobial resistance. Prescribing practices vary widely. In Europe, for example, frequency of antibiotic prescribing differs threefold between countries with the highest and lowest antibiotic use. A similar disparity has been documented in northern and southern regions of Italy.

Italy has one of the highest antibiotic prescribing rates in Europe, however, prescriptions decreased by 5.3% in 2010 following two national information campaigns during the winters of 2009 and 2010.

Systematic reviews have shown that education/information campaigns can have moderate effects on prescribing practices, particularly when local culture and context are incorporated into the campaigns. The evidence provided part of the basis for an evaluation of a locally targeted information campaign designed to reduce excessive antibiotic prescribing.

Consequently, a recent study published in the British Medical Journal (BMJ) found that a educational effort targeted at patients, physicians and pharmacists resulted in a significant decrease in antibiotic use 5 months after implementation, reported MedPage Today.

The study found that antibiotic use in the geographic area of the educational campaign declined by 4.3% compared with an area in the vicinity not included in an education campaign that included posters, brochures, advertisements, and a newsletter for doctors and pharmacists. The study took place in certain Italian provinces.

Interestingly, although antibiotic use declined during the educational campaign, attitudes about antibiotic prescribing did not change appreciably, nor did expenditures for antibiotics, Giulio Formoso, MPH, of the Emilia-Romagna Regional Agency for Health and Social Care in Bologna, Italy, and co-authors wrote.

The authors wrote that “reduced prescribing was mediated by doctors’ endorsement of the campaign goals or by an “awareness of the campaign” factor rather than by a decrease in pressure from patients to get antibiotics or to patients’ participation in a ‘wait and see’ decision.”

“Among open questions, we also do not know whether this intervention affected the out-of-pocket purchase of antibiotics, and whether it helped to reduce antimicrobial resistance, which is favored but not exclusively determined by antibiotic use in humans,” they wrote.

“However, in the absence of a national campaign with large media coverage, our data show that such a small-scale campaign is feasible, is economically sustainable by local health authorities, and may be moderately effective in reducing antibiotic prescribing, with potential savings that may more than offset the initial investment.”

The study area was the provinces of Modena and Parma in northern Italy, home to approximately 1,150,000 residents. For comparison, the authors examined prescribing practices in adjacent provinces with a total population of about 3.25 million.

The campaign focused primarily on prescribing for upper respiratory tract infections. To identify the key messages, implementation strategy, and acceptance by health professionals, the authors interviewed 13 doctors within the two provinces included in the campaign. The interviews were conducted by patient counseling specialists, and the information was translated into campaign messages by communication specialists.

For the most part, the campaign messages related to antimicrobial resistance. The campaign motto was “Antibiotics, solution or problem?”

Cost of the intervention included $61,000 for media advertising and $56,000 for printed materials.

In October 2011 (pre-campaign) and March 2012 (post-campaign) investigators surveyed 600 residents in the campaign and control areas.

The primary outcome was the rate of antibiotic prescribing to outpatients during the 5-month assessment period. Antibiotic classes included in the analysis were beta-lactams, cephalosporins, monobactams, macrolides, lincosamides, quinolones, and glycopeptides.

During the campaign, the daily-doses prescribing rates were 20.0 in the intervention area and 21.0 in the control area, corresponding to decreases of 11.9% and 7.4%, respectively, in the 5 months before the study. In the rest of Italy, the prescribing rate declined by 3.2% (including 0.8% in the rest of northern Italy).

“Since the antibiotic expenditure for the same 5-month period the previous year amounted to $8 million, an estimate of the possible savings from using the intervention may range from $266,000 to $540,000,” the authors reported.

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