Individual feedback to reduce inappropriate antimicrobial prescriptions for treating acute upper respiratory infections in an outpatient setting of a Thai university hospital.

OBJECTIVES: Excessive use of antimicrobial agents for acute upper respiratory infections (URIs) is one of the most common problems in clinical practice. Interventions are required to reduce antimicrobial overuse in these common infections.

METHODS: During a 9-month study period (June 2014-February 2015), a quasi-experimental (pre-/post-) study was conducted among internal medicine residents and fellows in an outpatient setting of Siriraj Hospital, Thailand. The aim of the study was to determine the effectiveness of individual feedback to reduce inappropriate antimicrobial prescriptions for treating URIs. The administrative ICD-10 database was used to identify index physicians with at least one outpatient experience of URI. Data on antimicrobial prescriptions were extracted from the hospital pharmacy database. A confidential letter and SMS were sent to all index physicians about the extent of antimicrobial therapy they prescribed for treating URIs during the pre-intervention period.

RESULTS: The proportion of antimicrobial use among the index encounters showed a significant reduction from 34.7% in the pre-intervention period to 26.1% in the post-intervention period (P=0.02). Segmented logistic regression analysis confirmed the significant impact of the intervention on reducing antimicrobial prescriptions (P=0.02).

CONCLUSION: This integrated intervention is simple and non-labour intensive and may therefore be used sustainably in resource-limited settings.