Effects of a comprehensive antibiotic stewardship program on antibiotic prescribing for acute respiratory infections in rural facilities: a cluster randomized trial.
Summary
In a 34-cluster pragmatic RCT across rural China, a multifaceted, digitally enabled stewardship package reduced antibiotic prescribing for ARIs by 39 percentage points without increasing 30-day respiratory/sepsis hospitalizations. Embedding concise, evidence-based prompts in EMRs, peer feedback, and patient education proved scalable and safe.
Key Findings
- Antibiotic prescribing for ARIs fell from 71% to 26% with the stewardship program (adjusted risk difference −39 percentage points).
- No increase in 30-day hospitalizations for respiratory illness or sepsis (adjusted risk difference 0.2 percentage points).
- Intervention components included EMR-embedded prompts, clinician training, peer review feedback, and a patient education app.
Clinical Implications
Primary care systems can implement integrated digital decision support, audit-feedback, and patient education to curb ARI antibiotic overuse without compromising safety; payers and ministries can scale similar packages.
Why It Matters
Demonstrates at scale that digital, team-based stewardship can dramatically reduce inappropriate antibiotics for ARIs, a key driver of antimicrobial resistance, with immediate policy relevance.
Limitations
- Open-label design with potential contamination between clusters.
- Conducted during 2020–2021, when pandemic dynamics may have influenced ARI presentations and care-seeking.
Future Directions
Assess durability and cost-effectiveness over multiple seasons and regions, optimize component-level contributions, and evaluate adaptation to different EMR ecosystems.
Study Information
- Study Type
- RCT
- Research Domain
- Prevention
- Evidence Level
- I - Cluster randomized controlled trial with large sample demonstrating causal effect.
- Study Design
- OTHER