Researchers Say Antibiotic Prescribing Audits and Feedback Should Be Standard Procedure

One year after a pilot program was launched, researchers indicate doctors who received audits and feedback maintained lower levels of antibiotic prescriptions

Implementing antibiotic audits and mail-in feedback for doctors appears to help reduce antibiotic overprescribing by 5%, according to the findings of a new study, which may provide important guidance for reducing the long-term risks from “super-bug” infections.

Over-use of antibiotics has been a growing concern in recent years, as research has found that unnecessary prescriptions increase the risk of antibiotic-resistent infections, which are extremely difficult to treat, since the bacteria evolves and makes existing drugs ineffective.

In 2023, the United Nations warned that super-bugs pose a serious threat to human health, and cause millions of deaths each year around the world. The rising risks have largely been linked to doctor prescribing habits, since many medical providers readily doll out antibiotics, including for treatment of viral infections the drugs are not intended to treat.

According to the findings of a new study published this month in the medical journal The BMJ, implementing a pilot program involving audits and feedback not only helped reduce antibiotic prescriptions overall among doctors, but also reduced the rate of unnecessary prescriptions for ailments not treatable by antibiotics by 11%.

Reducing Unnecessary Antibiotic Use

Researchers from Public Health Ontario and the University of Ontario, led by Assistant Professor Kevin L. Schwartz, evaluated the effectiveness of feedback to family doctors on antibiotic prescribing, compared to a peer group reduced antibiotic prescriptions. The study included more than 5,000 primary care doctors in Ontario, Canada.

Doctors were randomly assigned to a feedback group or a control group. Doctors were mailed audit feedback letters in January 2022. The letters focused on details of their antibiotic prescribing habits and rates along with a comparison of habits and rates for other doctors in their same fields. They each were then matched with four doctors who did not receive feedback to serve as the control group.

Six months later, antibiotic prescribing overall was 5% lower in the feedback group. More importantly, the audits and feedback helped reduce unnecessary antibiotic prescribing by 11% for ailments that can’t be treated by antibiotic drugs, the researchers determined.

The feedback intervention also helped to reduce the number of antibiotic courses longer than seven days by 15% and reduced the number of prescriptions for broad-spectrum antibiotics, the most commonly prescribed type of antibiotic, by 6%.

Researchers followed up one year later and found the reduction in unnecessary antibiotic prescriptions continued to stay low in the feedback group.

Inappropriate antibiotic prescribing happens when doctors offer antibiotic prescriptions for conditions like urinary tract infections or viral infections that cannot be treated with antibiotics, as opposed to bacterial infections that require antibiotic treatment.

Prior research from the University of Ontario indicated roughly 25% of antibiotic prescriptions written by primary care doctors are unnecessary.

Audits and feedback can help reduce the proliferation of superbugs, slow the emergence of antibiotic-resistant infections overall, and improve the quality of patient care, researchers in this latest study determined. Doctor-prescribing feedback should be a routine expectation in primary care, they emphasized.

“Peer comparison audit and feedback letters significantly reduced overall antibiotic prescribing with no benefit of case-mix adjustment or harms messaging,” Schwartz and his team concluded. “Antibiotic prescribing audit and feedback is a scalable and effective intervention and should be a routine quality improvement initiative in primary care.”