Interventions to improve antibiotic prescribing in upper middle income countries: A systematic review of the literature 1990-2009

Abstract

Background: Inappropriate antibiotic use is a global public health problem with serious consequences, including antimicrobial resistance. In response, countries have to take comprehensive action with interventions that improve antibiotic use at various levels. Several reviews have evaluated interventions on antibiotic prescribing practices in different healthcare settings. Objective: To identify interventions targeting antibiotic prescribing by medical doctors in primary health care in upper middle-income countries and to assess intervention effectiveness. Methods: We undertook systematic literature review of studies for the period 1990 - 2009. Studies had to report quantitative data on antibiotic prescribing by primary care doctors using medicines use indicators. Intervention effects were based on data from intervention studies with valid study designs. Results: Eight studies describing ten interventions met all the inclusion criteria. We found that single educational interventions targeting all diseases had low or no impact on percentages of patients prescribed antibiotics. Greater impact on antibiotic prescribing was achieved by multifaceted interventions focusing on specific diseases. Conclusion: The limited evidence on interventions from upper middle-income countries has produced results similar to other reviews. More concerted commitment is needed to monitor antibiotic prescribing regularly and to conduct well designed evaluations of interventions. © 2012 Ivanovska V.