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Controlled Clinical Trial
. 2013 Sep 12:347:f5391.
doi: 10.1136/bmj.f5391.

Feasibility and effectiveness of a low cost campaign on antibiotic prescribing in Italy: community level, controlled, non-randomised trial

Giulio Formoso  1 , Barbara Paltrinieri, Anna Maria Marata, Carlo Gagliotti, Angelo Pan, Maria Luisa Moro, Oreste Capelli, Nicola Magrini; LOCAAL Study Group
Collaborators, Affiliations
Controlled Clinical Trial

Feasibility and effectiveness of a low cost campaign on antibiotic prescribing in Italy: community level, controlled, non-randomised trial

Giulio Formoso et al. BMJ. .

Abstract

Objectives: To test the hypothesis that a multifaceted, local public campaign could be feasible and influence antibiotic prescribing for outpatients.

Design: Community level, controlled, non-randomised trial.

Setting: Provinces of Modena and Parma in Emilia-Romagna, northern Italy, November 2011 to February 2012.

Population: 1,150,000 residents of Modena and Parma (intervention group) and 3,250,000 residents in provinces in the same region but where no campaign had been implemented (control group).

Interventions: Campaign materials (mainly posters, brochures, and advertisements on local media, plus a newsletter on local antibiotic resistance targeted at doctors and pharmacists). General practitioners and paediatricians in the intervention area participated in designing the campaign messages.

Main outcomes measures: Primary outcome was the average change in prescribing rates of antibiotics for outpatient in five months, measured as defined daily doses per 1000 inhabitants/day, using health districts as the unit of analysis.

Results: Antibiotic prescribing was reduced in the intervention area compared with control area (-4.3%, 95% confidence interval -7.1% to -1.5%). This result was robust to "sensitivity analysis" modifying the baseline period from two months (main analysis) to one month. A higher decrease was observed for penicillins resistant to β lactamase and a lower decrease for penicillins susceptible to β lactamase, consistent with the content of the newsletter on antibiotic resistance directed at health professionals. The decrease in expenditure on antibiotics was not statistically significant in a district level analysis with a two month baseline period (main analysis), but was statistically significant in sensitivity analyses using either a one month baseline period or a more powered doctor level analysis. Knowledge and attitudes of the target population about the correct use of antibiotics did not differ between the intervention and control areas.

Conclusions: A local low cost information campaign targeted at citizens, combined with a newsletter on local antibiotic resistance targeted at doctors and pharmacists, was associated with significantly decreased total rates of antibiotic prescribing but did not affect the population's knowledge and attitudes about antibiotic resistance.

Trial registration: ClinicalTrials.gov NCT01604096.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no individual support from any organisation for the submitted work aside from the Italian Medicines Agency grant (Bando AIFA 2008); no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work, which has not been scientifically influenced by the study sponsor in any way as well.

Figures

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Prescription of antibiotics in intervention and control area from June 2010 to March 2012. DDD=defined daily doses
See this image and copyright information in PMC

Comment in

References

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    1. Huttner B, Goossens H, Verheij T, Harbarth S, on behalf of the CHAMP consortium. Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis 2010;10:17-31. - PubMed
    1. Second report from the European Commission to the Council of Europe, on the basis of Member States’ reports on the implementation of the Council recommendation (2002/77/ec) on the prudent use of antimicrobial agents in human medicine. http://ec.europa.eu/health/antimicrobial_resistance/docs/amr_report2_en.pdf.
    1. World Health Organization. The evolving threat of antimicrobial resistance. Options for action. WHO Press, 2012. http://whqlibdoc.who.int/publications/2012/9789241503181_eng.pdf.

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