Long-Term Behavioral Interventions on Inappropriate Antibiotic Prescribing

Doctor writing a prescription
Doctor writing a prescription
Inappropriate prescribing of antibiotics is a contributing factor in antibiotic resistance.

A cluster-randomized controlled trial with behavioral interventions aimed at decreasing inappropriate antibiotic prescribing for acute respiratory infections (ARIs) was shown to continue to reduce such prescribing during a 12-month period after the interventions were stopped, according to a research letter published in JAMA.

The researchers who conducted the study of 47 primary care practices did find, however, that after stopping the behavioral interventions aimed at decreasing antibiotic prescribing for adults with nonspecific upper respiratory tract infections, acute bronchitis, and influenza, prescribing antibiotics in those settings again increased. The control practices – which received no interventions – meanwhile showed a steady decline in inappropriate antibiotic prescribing from the 18 months of monitoring before interventions were begun, throughout the 18-month intervention period, and during the 12-month follow-up.

The study included 3 behavioral interventions aimed at decreasing the inappropriate antibiotic prescribing that contributes to antibiotic resistance and adverse events. Two interventions were electronic health record based: one suggested an alternative treatment when a physician began to prescribe antibiotics for ARIs, and the second prompted physicians to justify such prescribing. A third intervention, the one that proved most effective and most lasting, involved providing peer comparisons of antibiotic prescribing rates for ARIs. The latter intervention continued to result in significantly fewer antibiotic prescriptions for ARIs during the postintervention period than were written in the control practices (P <.001; 1-tailed test); accountable justification was not different from the control (P =.99; 1-tailed test).The researchers suggest that peer comparison might have prompted clinicians to make judicious antibiotic prescribing habits part of their professional self-image.

The researchers caution that as the postintervention period was only 12 months, the beneficial effects of the behavioral methods might further decrease with additional time. To avoid this, they suggest long-term implementation of such interventions.

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Dr Persell reported receiving grant funding from Pfizer and personal fees from Omron Healthcare. Dr Doctor reported receiving consulting fees from Precision Health Economics.


Linder JA, Meeker D, Fox CR, et al. Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventionsJAMA. 2017;318(14):1391-1392.