Impact of a Social Marketing Intervention on General Practitioners’ Antibiotic Prescribing Practices for Acute Respiratory Tract Complaints in Malta

Introduction: Antibiotics are commonly prescribed in primary care for acute respiratory tract complaints (aRTCs), often inappropriately. Social marketing interventions could improve prescribing in such settings. We evaluate the impact of a social marketing intervention on general practitioners’ (GPs’) antibiotic prescribing for aRTCs in Malta. Methods: Changes in GPs’ antibiotic prescribing were monitored over two surveillance periods between 2015 and 2018. Primary outcome: change in antibiotic prescription for aRTCs. Secondary outcomes: change in antibiotic prescription: (i) for immediate use, (ii) for delayed antibiotic prescription, (iii) by diagnosis, and (iv) by antibiotic class. Data were analysed using clustered analysis and interrupted time series analysis (ITSA). Results: Of 33 participating GPs, 18 successfully completed the study. Although clustered analyses showed a significant 3% decrease in overall antibiotic prescription (p = 0.024), ITSA showed no significant change overall (p = 0.264). Antibiotic prescription decreased significantly for the common cold (p < 0.001), otitis media (p = 0.044), and sinusitis (p = 0.004), but increased for pharyngitis (p = 0.015). Conclusions: The intervention resulted in modest improvements in GPs’ antibiotic prescribing. A more top-down approach will likely be required for future initiatives to be successful in this setting, focusing on diagnostic and prescribing support like rapid diagnostic testing, prescribing guidelines, and standardised delayed antibiotic prescriptions.

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The impact of pulse oximetry and Integrated Management of Childhood Illness (IMCI) training on antibiotic prescribing practices in rural Malawi: a mixed-methods study

10.21203/rs.3.rs-23789/v1 ◽

2020 ◽

Author(s):

Fiona Sylvies ◽

Lucy Nyirenda ◽

Alden Blair ◽

Kimberly Baltzell

Keyword(s):

Pulse Oximeter ◽

Antibiotic Prescription ◽

Integrated Management ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Continued Education ◽

Pediatric Pneumonia ◽

Prescription Rates ◽

The Impact ◽

Pulse Oximeters

Abstract Background. The misdiagnosis of non-malarial fever in sub-Saharan Africa has contributed to the significant burden of pediatric pneumonia and the inappropriate use of antibiotics in this region. This study aims to assess the impact of 1) portable pulse oximeters and 2) Integrated Management of Childhood Illness (IMCI) continued education training on the diagnosis and treatment of non-malarial fever amongst pediatric patients being treated by the Global AIDS Interfaith Alliance (GAIA) in rural Malawi. Methods. This study involved a logbook review to compare treatment patterns between five GAIA mobile clinics in Mulanje, Malawi during April-June 2019. An intervention study design was employed with four study groups: 1) 2016 control, 2) 2019 control, 3) IMCI-only, and 4) IMCI and pulse oximeter. A total of 3,504 patient logbook records were included based on these inclusion criteria: age under five years, febrile, malaria-negative, and treated during the dry season. A qualitative questionnaire was distributed to the participating GAIA providers. Fisher’s Exact Testing and odds ratios were calculated to compare the prescriptive practices between each study group and reported with 95% confidence intervals. Results. The pre- and post-exam scores for the providers who participated in the IMCI training showed an increase in content knowledge and understanding (p<0.01). The antibiotic prescription rates in each study group were 75% (2016 control), 85% (2019 control), 84% (IMCI only), and 42% (IMCI + pulse oximeter) (p<0.01). An increase in pneumonia diagnoses was detected for patients who received pulse oximeter evaluation with an oxygen saturation <95% (p<0.01). No significant changes in antibiotic prescribing practices were detected in the IMCI-only group (p>0.05). However, provider responses to the qualitative questionnaires indicated alternative benefits of the training including improved illness classification and increased provider confidence. Conclusion. Clinics that implemented both the IMCI course and pulse oximeters exhibited a significant decrease in antibiotic prescription rates, thus highlighting the potential of this tool in combatting antibiotic overconsumption in low-resource settings. Additionally, the pulse oximeters demonstrated the capacity to improve detection of pediatric pneumonia. GAIA staff appreciated the IMCI continued education training, however it did not appear to significantly impact antibiotic prescription rates and/or pneumonia diagnosis.

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The impact of pulse oximetry and Integrated Management of Childhood Illness (IMCI) training on antibiotic prescribing practices in rural Malawi: A mixed-methods study

PLoS ONE ◽

10.1371/journal.pone.0242440 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242440

Author(s):

Fiona Sylvies ◽

Lucy Nyirenda ◽

Alden Blair ◽

Kimberly Baltzell

Keyword(s):

Pulse Oximeter ◽

Pediatric Patients ◽

Antibiotic Prescription ◽

Integrated Management ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Continued Education ◽

Prescription Rates ◽

The Impact ◽

Pulse Oximeters

Background The misdiagnosis of non-malarial fever in sub-Saharan Africa has contributed to the significant burden of pediatric pneumonia and the inappropriate use of antibiotics in this region. This study aims to assess the impact of 1) portable pulse oximeters and 2) Integrated Management of Childhood Illness (IMCI) continued education training on the diagnosis and treatment of non-malarial fever amongst pediatric patients being treated by the Global AIDS Interfaith Alliance (GAIA) in rural Malawi. Methods This study involved a logbook review to compare treatment patterns between five GAIA mobile clinics in Mulanje, Malawi during April-June 2019. An intervention study design was employed with four study groups: 1) 2016 control, 2) 2019 control, 3) IMCI-only, and 4) IMCI and pulse oximeter. A total of 3,504 patient logbook records were included based on these inclusion criteria: age under five years, febrile, malaria-negative, and treated during the dry season. A qualitative questionnaire was distributed to the participating GAIA providers. Fisher’s Exact Testing and odds ratios were calculated to compare the prescriptive practices between each study group and reported with 95% confidence intervals. Results The pre- and post-exam scores for the providers who participated in the IMCI training showed an increase in content knowledge and understanding (p<0.001). The antibiotic prescription rates in each study group were 75% (2016 control), 85% (2019 control), 84% (IMCI only), and 42% (IMCI + pulse oximeter) (p<0.001). An increase in pneumonia diagnoses was detected for patients who received pulse oximeter evaluation with an oxygen saturation <95% (p<0.001). No significant changes in antibiotic prescribing practices were detected in the IMCI-only group (p>0.001). However, provider responses to the qualitative questionnaires indicated alternative benefits of the training including improved illness classification and increased provider confidence. Conclusion Clinics that implemented both the IMCI course and pulse oximeters exhibited a significant decrease in antibiotic prescription rates, thus highlighting the potential of this tool in combatting antibiotic overconsumption in low-resource settings. Enhanced detection of hypoxia in pediatric patients was regarded by clinicians as helpful for identifying pneumonia cases. GAIA staff appreciated the IMCI continued education training, however it did not appear to significantly impact antibiotic prescription rates and/or pneumonia diagnosis.

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Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

BMC Health Services Research ◽

10.1186/s12913-020-05771-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Michael Mireku Opoku ◽

Harriet Affran Bonful ◽

Kwadwo Ansah Koram

Keyword(s):

Antibiotic Prescription ◽

Secondary Data ◽

Health Facilities ◽

Full Blood Count ◽

Baseline Survey ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Factors Associated ◽

Laboratory Investigations ◽

Greater Accra Region

Abstract Background Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p < 0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy198 ◽

2018 ◽

Vol 5 (9) ◽

Cited By ~ 27

Author(s):

Michael J Durkin ◽

Matthew Keller ◽

Anne M Butler ◽

Jennie H Kwon ◽

Erik R Dubberke ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Antibiotic Use ◽

Emergency Department Visits ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Duration Of Treatment ◽

Minimal Impact ◽

Tract Infections ◽

The Impact

Abstract Background In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices. Methods We performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration. Results We identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with >75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers. Conclusions Inappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

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Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz018 ◽

2019 ◽

Vol 6 (2) ◽

Cited By ~ 8

Author(s):

Sophia Jung ◽

Mary Elizabeth Sexton ◽

Sallie Owens ◽

Nathan Spell ◽

Scott Fridkin

Keyword(s):

Antibiotic Prescription ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Clinic ◽

Multivariable Logistic Regression Analysis ◽

Comorbid Condition ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Care Clinic ◽

The Impact

Abstract Background In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

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Antibiotic Prescribing Practices and Errors among Hospitalized Pediatric Patients Suffering from Acute Respiratory Tract Infections: A Multicenter, Cross-Sectional Study in Pakistan

Medicina ◽

10.3390/medicina55020044 ◽

2019 ◽

Vol 55 (2) ◽

pp. 44 ◽

Cited By ~ 4

Author(s):

Sadia Iftikhar ◽

Muhammad Rehan Sarwar ◽

Anum Saqib ◽

Muhammad Sarfraz ◽

Qurat-ul-ain Shoaib

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Public Hospitals ◽

P Value ◽

Antibiotic Prescribing ◽

Prescribing Errors ◽

Prescribing Practices ◽

Cross Sectional ◽

Acute Respiratory Tract Infections ◽

Tract Infections

Background and objective: The noncompliance of treatment guidelines by healthcare professionals, along with physiological variations, makes the pediatric population more prone to antibiotic prescribing errors. The present study aims to evaluate the prescribing practices and errors of the most frequently prescribed antibiotics among pediatric patients suffering from acute respiratory tract infections who had different lengths of stay (LOS) in public hospitals. Methods: A retrospective, cross-sectional study was conducted in five tertiary-care public hospitals of Lahore, Pakistan, between 1 January 2017 and 30 June 2017. The study population consisted of pediatric inpatients aged 0 to 9 years. Results: Among the 11,892 pediatric inpatients, 82.8% were suffering from lower acute respiratory tract infections and had long LOS (53.1%) in hospital. Penicillins (52.4%), cephalosporins (16.8%), and macrolides (8.9%) were the most frequently prescribed antibiotics. Overall, 40.8% of the cases had antibiotic prescribing errors related to wrong dose (19.9%), wrong frequency (18.9%), and duplicate therapy (18.1%). Most of these errors were found in the records of patients who had long LOS in hospital (53.1%). Logistic regression analysis revealed that the odds of prescribing errors were lower in female patients (OR = 0.6, 95% CI = 0.1–0.9, p-value = 0.012). Patients who were prescribed with ≥3 antibiotics per prescription (OR = 1.724, 95% CI = 1.1–2.1, p-value = 0.020), had long LOS (OR = 12.5, 95% CI = 10.1–17.6, p-value < 0.001), and were suffering from upper respiratory tract infections (URTI) (OR = 2.8, 95% CI = 1.7–3.9, p-value < 0.001) were more likely to experience prescribing errors. Conclusion: Antibiotics were commonly prescribed to patients who had long LOS. Prescribing errors (wrong dose, wrong frequency, and duplicate therapy) were commonly found in cases of lower respiratory tract infections (LRTIs), especially among those who had prolonged stay in hospital.

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General practitioners’ perceptions of delayed antibiotic prescription for respiratory tract infections: A phenomenographic study

PLoS ONE ◽

10.1371/journal.pone.0225506 ◽

2019 ◽

Vol 14 (11) ◽

pp. e0225506 ◽

Cited By ~ 3

Author(s):

Erika A. Saliba-Gustafsson ◽

Marta Röing ◽

Michael A. Borg ◽

Senia Rosales-Klintz ◽

Cecilia Stålsby Lundborg

Keyword(s):

Respiratory Tract ◽

General Practitioners ◽

Respiratory Tract Infections ◽

Antibiotic Prescription ◽

Phenomenographic Study ◽

Tract Infections ◽

Delayed Antibiotic Prescription

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148. Implementation of Restriction Criteria within an Electronic Medical Record and Its Impact on Carbapenem Prescribing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.350 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S186-S186

Author(s):

Mandana Naderi ◽

Kimberly Welker ◽

Gary Chan ◽

David Nix

Keyword(s):

Health System ◽

Retrospective Cohort ◽

Interrupted Time Series ◽

Antibiotic Prescribing ◽

Interrupted Time Series Analysis ◽

Prescribing Practices ◽

Post Intervention ◽

Days Of Therapy ◽

History Of ◽

Selection For

Abstract Background Carbapenem restriction criteria (CRC) were developed by our health system to conserve the prescribing of these broad-spectrum agents. The purpose of this study was to compare pre and post EMR implementation of adherence to the system-approved CRC and if there was an association with decreased utilization of carbapenems. Methods A retrospective cohort review from January 2018 to June 2020 was performed via the Cerner EMR at 3 community hospitals in Arizona (AZ) and California (CA) to determine if CRC was appropriate at time of carbapenem initiation. Admitted patients > 18 years prescribed meropenem or ertapenem and received at least one dose were included. Health System approved CRC are shown in Table 2. Results A total of 160 patients were analyzed, including 60 pre-EMR CRC intervention and 100 post intervention. Forty-five patients (28%) had a documented history of ESBL infection as shown in Table 1. Figure 1 shows carbapenem utilization over the study period. An interrupted time series analysis was performed for both AZ and CA. After correcting for pre-intervention trends, AZ days of therapy (DOT) decreased by 6.2 DOT per 1000 patient days within 1 month post intervention (23%, p< 0.0001); the model predicted a further drop of 0.6 DOT per 1000 patient days per month over the 6 months post intervention. The CA DOT decreased by 1.2 DOT per 1000 patient days 1 month post intervention (17%, p= 0.28), with a predicted further drop of 0.28 DOT per 1000 patient days per month over the 6-month period post intervention. Post implementation retrospective review as described in Table 2 aligned with EMR restriction criteria selection for 68% of patients; interfacility differences occurred with 96% of CA reviews supported by criteria and 59% of AZ reviews supported by criteria (p= 0.0025). Conclusion This analysis supports that implementation of an EMR tool is an effective intervention to decrease unnecessary carbapenem use at the time of prescribing. The ESBL rate was similar pre and post intervention which may indicate that decreases in DOT were not due to a difference in MDRO rate. This study also highlights the different baseline antibiotic prescribing practices that may exist between facilities. Disclosures All Authors: No reported disclosures

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Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: pragmatic cluster randomised trial

BMJ ◽

10.1136/bmj.n2132 ◽

2021 ◽

pp. n2132

Author(s):

Loïc Lhopitallier ◽

Andreas Kronenberg ◽

Jean-Yves Meuwly ◽

Isabella Locatelli ◽

Yolanda Mueller ◽

...

Keyword(s):

Confidence Interval ◽

Respiratory Tract ◽

Usual Care ◽

General Practitioners ◽

Lower Respiratory Tract ◽

Antibiotic Prescription ◽

Point Of Care ◽

Care Group ◽

Lung Ultrasonography ◽

Cluster Randomised

Abstract Objective To assess whether point-of care procalcitonin and lung ultrasonography can safely reduce unnecessary antibiotic treatment in patients with lower respiratory tract infections in primary care. Design Three group, pragmatic cluster randomised controlled trial from September 2018 to March 2020. Setting 60 Swiss general practices. Participants One general practitioner per practice was included. General practitioners screen all patients with acute cough; patients with clinical pneumonia were included. Interventions Randomisation in a 1:1:1 of general practitioners to either antibiotics guided by sequential procalcitonin and lung ultrasonography point-of-care tests (UltraPro; n=152), procalcitonin guided antibiotics (n=195), or usual care (n=122). Main outcomes Primary outcome was proportion of patients in each group prescribed an antibiotic by day 28. Secondary outcomes included duration of restricted activities due to lower respiratory tract infection within 14 days. Results 60 general practitioners included 469 patients (median age 53 years (interquartile range 38-66); 278 (59%) were female). Probability of antibiotic prescription at day 28 was lower in the procalcitonin group than in the usual care group (0.40 v 0.70, cluster corrected difference −0.26 (95% confidence interval −0.41 to −0.10)). No significant difference was seen between UltraPro and procalcitonin groups (0.41 v 0.40, −0.03 (−0.17 to 0.12)). The median number of days with restricted activities by day 14 was 4 days in the procalcitonin group and 3 days in the usual care group (difference 1 day (95% confidence interval −0.23 to 2.32); hazard ratio 0.75 (95% confidence interval 0.58 to 0.97)), which did not prove non-inferiority. Conclusions Compared with usual care, point-of-care procalcitonin led to a 26% absolute reduction in the probability of 28 day antibiotic prescription without affecting patients’ safety. Point-of-care lung ultrasonography did not further reduce antibiotic prescription, although a potential added value cannot be excluded, owing to the wide confidence intervals. Trial registration ClinicalTrials.gov NCT03191071 .

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2067. Improving Outpatient Antimicrobial Prescribing for Respiratory Tract Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1747 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S696-S697

Author(s):

Lauren S Dutcher ◽

Kathleen Degnan ◽

Ebbing Lautenbach ◽

David A Pegues ◽

Michael Z David ◽

...

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Primary Diagnosis ◽

Ambulatory Setting ◽

Antibiotic Prescribing ◽

Stepped Wedge ◽

Antimicrobial Prescribing ◽

Tract Infections ◽

Tier 3 ◽

The Impact

Abstract Background Antimicrobial stewardship often focuses on inpatients, yet inappropriate antimicrobial use is common in the outpatient setting. We performed a prospective, stepped wedge interventional study to assess the impact of an educational and feedback-based intervention on prescribing practices for respiratory tract infections (RTIs) in the adult primary care ambulatory setting. Methods Family and internal medicine practices were randomly placed into 6 cohorts, which received the intervention in a stepped wedge fashion at monthly intervals. The study period was July 1, 2016 to October 31, 2018, with the intervention occurring from October 1, 2017 to October 31, 2018. The intervention consisted of a 20-minute in-person educational session on appropriate antimicrobial prescribing for RTIs followed by monthly feedback to individual providers on their proportion of antibiotic prescriptions in comparison to their peers for (1) visits with a primary diagnosis of any RTI and (2) visits with a primary diagnosis of an RTI for which an antibiotic should rarely be prescribed (tier 3 diagnoses). The outcome of interest was whether an antibiotic was prescribed in RTI visits. Chi squared testing and logistic regression were used for analysis. Results Thirty-two practices participated, with 197,814 unique visits with a primary RTI diagnosis. Of these, 141,888 (71.7%) were physician visits and 55,926 (28.3%) were advanced practitioner visits (Figure 1). The proportion of visits with antibiotic prescriptions dropped from 37.2% to 24.0% following the intervention (P < 0.0001). Antibiotic prescriptions were significantly reduced for all primary RTI visits, OR 0.53 (95% CI 0.52 to 0.54), as well as for visits with tier 3 RTI diagnoses, OR 0.64 (95% CI 0.60 to 0.68). The proportion of visits with antibiotic prescriptions also exhibited a marked seasonal variation, another finding of the study (Figure 2). Conclusion An educational intervention with provider feedback successfully reduced antibiotic prescribing for RTIs in the ambulatory setting. Additional study is necessary to assess the sustainability of response over time after discontinuation of the monthly feedback. Disclosures All authors: No reported disclosures.

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