| Teng et al., Malaysia, 2006 [277] |
Education—Academic detailing from the resident family medicine specialist accompanied by an information leaflet |
Reduction in general antibiotic prescribing rates from 14.3% pre-intervention to 11.0% post-intervention (RR 0.77, 95% CI 0.72 to 0.83) Reduction in URTI-specific antibiotic prescribing rates from 27.7% and 16.6% post-intervention (RR 0.60, 95% CI 0.54 to 0.66).
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| Shrestha et al., Nepal, 2006 [278] |
Principally Education—7 health posts and 33 subhealth posts were stratified by type with health workers. The intervention was based on 5 days of training on the adapted Practical Approach to Lung Health (PAL) guidelines and their use |
Appropriate prescribing of antibiotics and adherence to guidelines improved However, this was not statistically significant unlike other areas such as polypharmacy and generic prescribing rates
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| Awad et al., Sudan, 2006 [279] |
Twenty health centers in Khartoum State were randomly assigned to receive either (a) no intervention; (b) audit and feedback; (c) audit and feedback + seminar; or (d) audit and feedback + academic detailing The targeted interventions involving audit and feedback combined with academic detailing
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Significant reduction in the mean number of physician encounters with an antibiotic prescribed by 6.3 and 7.7 (p < 0.001) at 1 and 3 months post-intervention respectively The mean number of encounters where antibiotics were inappropriately prescribed were also significantly reduced post-intervention (p < 0.001) However, reducing the number of interventions reduced their overall impact
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| Kafle et al., Nepal, 2009 [280] |
Principally Education—Supervision/monitoring involving periodic visits by district supervisors to 41 primary healthcare (PHC) facilities The intervention included small-group training among prescribers followed by peer-group discussions alongside self-assessment of the data presented
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In children under five, there was a significant improvement in use of antimicrobials in diarrhea There was also a significant improvement in the prescribing of antibiotics for URTIs without pneumonia
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| Yip et al., China, 2014 [281] |
Principally Economics: In Ningxia Province, a randomized study was undertaken to evaluate the effects of capitation with pay-for-performance on antibiotic prescribing practices, health spending, outpatient visit volumes, and patient satisfaction |
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| Boonyasiri et al., Thailand, 2014 [282] |
Principally Education including:
Training HCPs on the rational use of antibiotics Introduction of clinical practice guidelines Potential for throat swabs (stool cultures for acute diarrhea) Printed brochures for patients/relatives in waiting rooms containing likely etiology as well necessity and harm of antibiotics for URIs and acute diarrhea
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The multifaceted program resulted in:
Limited prescribing of antibiotics for URIs (13.0%) and for acute diarrhea (19.1%) Clinical responses on day 3 after receiving care revealed more than 97% of the patients who received antibiotics/those who did not receive antibiotics were cured or improved
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| Wei et al., China, 2019 [273] |
Principally Education The multiple interventions comprised: clinical guidelines, monthly prescribing review meetings, doctor–patient communication skills training, and education materials for caregivers
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This multifaceted approach appreciably reduced prescribing rates for antibiotics (ABR) in children with URTIs:
A 49% reduction in ABR after 6 months in the intervention arm having adjusted for patient and prescribing doctor covariates The reductions persisted after 18 months but at a lower rate (−36%) Factors sustaining the reduction included physicians’ improved knowledge and communication skills combined with focused prescription review meetings
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| Tay et al., Malaysia, 2019 [283] |
Principally Education—Educational toolkits included a training module for HCPs on URI and acute diarrhoea involving:
One-hour educational sessions covering diagnostic criteria and treatment decision pathways Educational posters in Malay and English in the waiting area and consultation rooms as well as multimedia educational videos in the waiting areas Physician reminders
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Appreciable reduction in antibiotic prescribing:
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