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急性呼吸道感染的初级医疗中，影响临床医生抗生素处方行为的干预措施：一项基于系统综述的概述

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Referencias

References to included reviews

Ir a:

Aabenhus 2014

Aabenhus R, Jensen JUS, Jørgensen KJ, Hróbjartsson A, Bjerrum L. Biomarkers as point‐of‐care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database of Systematic Reviews 2014, Issue 11. [DOI: 10.1002/14651858.CD010130.pub2]

Arnold 2005

Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database of Systematic Reviews 2005, Issue 4. [DOI: 10.1002/14651858.CD003539.pub2]

Boonacker 2010

Boonacker CWB, Hoes AW, Dikhoff M, Schilder AGM, Rovers MM. Interventions in health care professionals to improve treatment in children with upper respiratory tract infections. International Journal of Pediatric Otorhinolaryngology 2010;74:1113‐21.

Coxeter 2015

Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database of Systematic Reviews 2015, Issue 11. [DOI: 10.1002/14651858.CD010907.pub2]

de Bont 2015

de Bont EGPM, Alink M, Falkenberg FCJ, Dinant G‐J, Cals JWL. Patient information leaflets to reduce antibiotic use and reconsultation rates in general practice: a systematic review. BMJ Open 2015;5:e007612. [DOI: 10.1136/bmjopen‐2015‐007612]

Doan 2014

Doan Q, Enarson P, Kissoon N, Klassen TP, Johnson DW. Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department. Cochrane Database of Systematic Reviews 2014, Issue 9. [DOI: 10.1002/14651858.CD006452.pub4]

Huang 2013

Huang Y, Chen R, Wu T, Wei X, Guo A. Association between point‐of‐care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta‐analysis of primary care studies. British Journal of General Practice 2013;63(616):e787‐94.

Schuetz 2012

Schuetz P, Müller B, Christ‐Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database of Systematic Reviews 2012, Issue 9. [DOI: 10.1002/14651858.CD007498.pub2]

References to excluded reviews

Ir a:

Andrews 2012

Andrews T, Thompson M, Buckley DI, Heneghan C, Deyo R, Redmond N, et al. Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta‐analysis. PLoS ONE 2012;7(1):e30334. [DOI: 10.1371/journal.pone.0030334]

Arroll 2003

Arroll B, Kenealy T, Kerse N. Do delayed prescriptions reduce antibiotic use in respiratory tract infections? a systematic review. British Journal of General Practice 2003;53:871‐7.

Cooke 2015

Cooke J, Butler C, Hopstaken R, Drydan MS, McNulty C, Hurding S, et al. Narrative review of primary care point‐of‐care testing (POCT) and antibacterial use in respiratory tract infection (RTI). BMJ Open Respiratory Research 2015;2:e000086. [DOI: 10.1136/bmjresp‐2015‐000086]

Engel 2012

Engel MF, Paling FP, Hoepelman AIM, van der Meer V, Oosterheert JJ. Evaluating the evidence for the implementation of C‐reactive protein measurement in adult patients with suspected lower respiratory tract infection in primary care: a systematic review. Family Practice 2012;29:383‐93.

Gross 2001

Gross PA, Pujat D. Implementing practice guidelines for appropriate antimicrobial usage: a systematic review. Medical Care 2001;39(8):Suppl 2: II‐55‐69.

Patel 2007

Patel SJ, Larson EL, Kubin CJ, Saiman L. A review of antimicrobial control strategies in hospitalized and ambulatory pediatric populations. Pediatric Infectious Disease Journal 2007;26:531‐7.

Petrozzino 2010

Petrozzino JJ, Smith C, Atkinson MJ. Rapid diagnostic testing for seasonal influenza: an evidence‐based review and comparison with unaided clinical diagnosis. Journal of Emergency Medicine 2010;39(4):476‐90.

Ranji 2008

Ranji SR, Steinman MA, Shojania KG, Gonzales R. Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis. Medical Care 2008;46:847‐62.

Rausch 2009

Rausch S, Flammang M, Haas N, Stein R, Tabouring P, Delvigne S, et al. C‐reactive protein to initiate or withhold antibiotics in acute respiratory tract infections in adults, in primary care: review. Bulletin de la Société des sciences médicales du Grand‐Duché de Luxembourg [Bulletin of the Society of Medical Sciences of the Grand Duchy of Luxembourg] 2009;1:79‐87.

Schuetz 2011

Schuetz P, Chiappa V, Briel M, Greenwald JL. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Archives of Internal Medicine 2011;171(15):1322‐31.

Schuetz 2013

Schuetz P, Müller B, Christ‐Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections (Review). Evidence‐Based Child Health 2013;8(4):1297–371. [DOI: 10.1002/ebch.1927]

Spurling 2013

Spurling GKP, Del Mar CB, Dooley L, Foxlee R, Farley R. Delayed antibiotics for respiratory infections. Cochrane Database of Systematic Reviews 2013, Issue 4. [DOI: 10.1002/14651858.CD004417.pub4]

van der Does 2016

van der Does Y, Rood PPM, Haagsma JA, Patka P, van Gorp ECM, Limper M. Procalcitonin‐guided therapy for the initiation of antibiotics in the ED: a systematic review. American Journal of Emergency Medicine 2016;34:1286–93.

van der Velden 2012

van der Velden AW, Pijpers EJ, Kuyvenhoven MM, Tonkin‐Crine SKG, Little P, Verheij TJM. Effectiveness of physician‐targeted interventions to improve antibiotic use for respiratory tract infections. British Journal of General Practice 2012;62(605):e801‐7.

Vodicka 2013

Vodicka TA, Thompson M, Lucas P, Heneghan C, Blair PS, Buckley DI, et al. Reducing antibiotic prescribing for children with respiratory tract infections in primary care: a systematic review. British Journal of General Practice 2013;63(612):e445‐54. [DOI: 10.3399/bjgp13X669167]

Additional references

Ir a:

ACSQHC 2016

Australian Commission on Safety and Quality in Health Care (ACSQHC). AURA 2016: First Australian report on antimicrobial use and resistance in human health. www.safetyandquality.gov.au/publications/aura‐2016‐first‐australian‐report‐on‐antimicrobial‐use‐and‐resistance‐in‐human‐health/ (accessed 20 April 2017).

Adriaenssens 2011

Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, et al. European surveillance of antimicrobial consumption (ESAC): outpatient antibiotic use in Europe (1997–2009). Journal of Antimicrobial Chemotherapy 2011;66(Suppl 6):vi3‐12.

Altiner 2007

Altiner A, Brockmann S, Sielk M, Wilm S, Wegscheider K, Abholz HH. Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster randomized intervention study. Journal of Antimicrobial Chemotherapy 2007;60:638‐44.

Andreeva 2014

Andreeva E, Melbye H. Usefulness of C‐reactive protein testing in acute cough/respiratory tract infection: an open cluster‐randomised clinical trial with CRP testing in the intervention group. BMC Family Practice 2014;15:80.

Bonner 2003

Bonner AB, Monroe KW, Talley LI, Klasner AE, Kimberlin DW. Impact of the rapid diagnosis of influenza on physician decision‐making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics 2003;112(2):363‐7.

Briel 2006

Briel M, Langewitz W, Tschudi P, Young J, Hugenschmidt C, Bucher HC. Communication training and antibiotic use in acute respiratory tract infections. A cluster randomised controlled trial in general practice. Swiss Medical Weekly 2006;136:241‐7.

Briel 2008

Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, et al. Procalcitonin‐guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Archives of Internal Medicine 2008;168(18):2000‐7.

Burkhardt 2010

Burkhardt O, Ewig S, Haagen U, Giersdorf S, Hartmann O, Wegscheider K, et al. Procalcitonin guidance and reduction of antibiotic use in acute respiratory tract infection. European Respiratory Journal 2010;36(3):601‐7.

Butler 2012

Butler CC, Simpson SA, Dunstan F, Rollnick S, Cohen D, Gillespie D, et al. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ 2012;344:d8173.

Cals 2009

Cals JW, Butler CC, Hopstaken RM, Hood K, Dinant GJ. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ 2009;338:b1374. [DOI: 10.1136/bmj.b1374]

Cals 2010

Cals JW, Schot MJ, de Jong SA, Dinant GJ, Hopstaken RM. Point‐of‐care C‐reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial. Annals of Family Medicine 2010;8(2):124‐33. [DOI: 10.1370/afm.1090]

Cals 2011

Cals JW, Ament AJ, Hood K, Butler CC, Hopstaken RM, Wassink GF, et al. C‐reactive protein point of care testing and physician communication skills training for lower respiratory tract infections in general practice: economic evaluation of a cluster randomized trial. Journal of Evaluation in Clinical Practice 2011;17(6):1059‐69.

Cals 2013

Cals JW, de Bock L, Beckers PJ, Francis NA, Hopstaken RG, Hood K, et al. Enhanced communication skills and C‐reactive protein point‐of‐care testing for respiratory tract infection: 3.5‐year follow‐up of a cluster randomized trial. Annals of Family Medicine 2013;11(2):157‐64.

CDC 2013

Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. www.cdc.gov/drugresistance/threat‐report‐2013/index.html (accessed 16 March 2016).

Christ‐Crain 2004

Christ‐Crain M, Jaccard‐Stolz D, Bingisser R, Gencay M, Huber P, Tamm M, et al. Effect of procalcitonin guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster‐randomised, single blinded intervention trial. Lancet 2004;1363(9409):600‐7.

Christ‐Crain 2006

Christ‐Crain M, Stolz D, Bingisser R, Muller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community‐acquired pneumonia: a randomized trial. American Journal of Respiratory and Critical Care Medicine 2006;174(1):84‐93.

Christakis 2001

Christakis DA, Zimmerman FJ, Wright JA, Garrison MM, Rivara FP, Davis RL. A randomized controlled trial of point‐of‐care evidence to improve the antibiotic prescribing practices for otitis media in children. Pediatrics 2001;107:E15.

Chung 2007

Chung A, Perera R, Brueggemann AB, Elamin AE, Harnden A, Mayon‐White R, et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. BMJ 2007;335(7617):429.

Costelloe 2010

Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta‐analysis. BMJ 2010;340:c2096.

Davey 2017

Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews 2017, Issue 2. [DOI: 10.1002/14651858.CD003543.pub4]

Diederichsen 2000

Diederichsen HZ, Skamling M, Diederichsen A, Grinsted P, Antonsen S, Petersen PH, et al. Randomised controlled trial of CRP rapid test as a guide to treatment of respiratory infections in general practice. Scandinavian Journal of Primary Health Care 2000;18:39‐43.

Doan 2009

Doan Q, Kissoon N, Whitehouse S, Dobson S, Cochrane D, Schmidt B, et al. A randomized, controlled trial of the impact of early and rapid diagnosis of viral infections in children brought to an Emergency Department with febrile respiratory tract illnesses. Journal of Pediatrics 2009;154(1):91‐5.

Finkelstein 2001

Finkelstein JA, Davis RL, Dowell SF, Metlay JP, Soumerai SB, Rifas‐Shiman SL, et al. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics 2001;108:1‐7.

Flottorp 2002

Flottorp S, Oxman AD, Havelsrud K, Treweek S, Herrin J. Cluster randomized controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat. BMJ 2002;325:367‐72.

Francis 2009

Francis NA, Butler CC, Hood K, Simpson S, Wood F, Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. BMJ 2009;339:374‐6.

Gonzales 2011

Gonzales R, Aagaard EM, Camargo CA, Ma OJ, Plautz M, Maselli J, et al. C‐reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm. Journal of Emergency Medicine 2011;41(1):1‐7.

Goossens 2005

Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross‐national database study. Lancet 2005;365(9459):579‐87.

Gulliford 2014

Gulliford MC, Dregan A, Moore MV, Ashworth M, van Staa T, McCann G, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open 2014;4:e006245.

Guyatt 2008

Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck‐Ytter Y, Schünemann HJ, GRADE Working Group. Rating quality of evidence and strength of recommendations: what is “quality of evidence” and why is it important to clinicians?. BMJ 2008;336(7651):995‐8.

Higgins 2011

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.

Hu 2016

Hu Y, Walley J, Chou R, Tucker JD, Harwell JI, Wu X, et al. Interventions to reduce childhood antibiotic prescribing for upper respiratory infections: systematic review and meta‐analysis. Journal of Epidemiology & Community Health 2016;70:1162–70.

Huttner 2013

Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, et al. Antimicrobial resistance: a global view from the 2013 World Healthcare‐Associated Infections Forum. Antimicrobial Resistance and Infection Control 2013;2:31.

Kristoffersen 2009

Kristoffersen KB, Sogaard OS, Wejse C, Black FT, Greve T, Tarp B, et al. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission ‐ a randomized trial. Clinical Microbiology and Infection 2009;15(5):481‐7.

Lancet 2009

Urgently needed: new antibiotics. Lancet 2009;374(9705):1868.

Little 2013

Little P, Stuart B, Francis N, Tonkin‐Crine S, Douglas E, Anthierens S, et al. The effect of web‐based training in communication skills and an interactive patient booklet and the use of a CRP point of care test in acute respiratory tract infection (RTI): a multi‐national cluster randomised factorial controlled trial. Lancet 2013;382(9899):1175‐82.

Long 2009

Long W, Deng XQ, Tang JG, Xie J, Zhang YC, Zhang Y, et al. Procalcitonin‐guidance for reduction of antibiotic use in low‐risk outpatients with community acquired pneumonia. Zhonghua Nei Ke Za Zhi 2009;48(3):216‐9.

Long 2011

Long W, Deng X, Zhang Y, Lu G, Xie J, Tang J. Procalcitonin‐guidance for reduction of antibiotic use in low‐risk outpatients with community acquired pneumonia. Respirology 2011;76(1):266‐9.

Légaré 2011

Légaré F, Labrecque M, LeBlanc A, Njoya M, Laurier C, Cote L, et al. Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial. Health Expectations 2011;14(Suppl 1):96‐110.

Légaré 2012

Légaré F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J. Training family physicians in shared decision making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. Canadian Medical Association Journal 2012;184:E726–34.

Macfarlane 1997

Macfarlane JT, Holmes WF, Macfarlane RM. Reducing reconsultations for acute lower respiratory tract illness with an information leaflet: a randomized controlled study of patients in primary care. British Journal of General Practice 1997;47:719‐22.

Mainous 2000

Mainous AG, Hueston WJ, Love MM, Evans ME, Finger R. An evaluation of statewide strategies to reduce antibiotic overuse. Family Medicine 2000;32:22‐9.

Makoul 2006

Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Education and Counseling 2006;60:301‐12.

Malhotra‐Kumar 2007

Malhotra‐Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide‐resistant streptococci in healthy volunteers: a randomised, double‐blind, placebo‐controlled study. Lancet 2007;369(9560):482‐90.

Martinez‐Gonzalez 2017

Martinez‐Gonzalez NA, Coenen S, Plate A, Colliers A, Rosemann T, Senn O, et al. The impact of interventions to improve the quality of prescribing and use of antibiotics in primary care patients with respiratory tract infections: a systematic review protocol. BMJ Open 2017;7(6):e016253.

McDonagh 2016

McDonagh M, Peterson K, Winthrop K, Cantor A, Holzhammer B, Buckley DI. Improving antibiotic prescribing for uncomplicated acute respiratory tract infections. Rockville (MD): Agency for Healthcare Research and Quality; January 2016. Comparative Effectiveness Review No. 163. (Prepared by the Pacific Northwest Evidence‐based Practice Center under Contract No. 290‐2012‐00014‐I.) AHRQ Publication Number: 15(16)‐EHC033‐ EF..

McIsaac 1998

McIsaac WJ, Goel V. Effect of an explicit decision‐support tool on decisions to prescribe antibiotics for sore throat. Medical Decision Making 1998;18:220‐8.

McIsaac 2002

McIsaac WJ, Goel V, To T, Permaul JA, Low DE. Effect on antibiotic prescribing of repeated clinical prompts to use a sore throat score: lessons from a failed community intervention study. Journal of Family Practice 2002;51:339‐44.

Melbye 1995

Melbye H, Aaraas I, Fleten N, Kolstrup N, Mikalsen J‐I. The value of C‐reactive protein testing in suspected lower respiratory tract infections. A study from general practice on the effect of a rapid test on antibiotic research and course of the disease in adults [Nytten av å teste C–reaktivt protein ved mulig nedre luftveisinfeksjon. En undersøkelse fran allmennpraksis av en hurtigtests innvirkning på antibiotikaforskrivning og sykdomsforløp hos voksne]. Tidsskrift for Norske Laegeforeningen 1995;115(13):1610–5.

Moore 2015

Moore G, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015;350:h1258.

O'Neill 2014

O'Neill J, Davies S, Rex J, White LJ, Murray R. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. amr‐review.org/sites/default/files/AMR%20Review%20Paper%20‐%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf (accessed 20 April 2017).

O'Sullivan 2016

O’Sullivan JW, Harvey RT, Glasziou PP, McCullough A. Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care. Cochrane Database of Systematic Reviews 2016, Issue 11. [DOI: 10.1002/14651858.CD011360.pub2]

PHE 2013

Public Health England. UK One Health Report. Joint report on human and animal antibiotic use, sales and resistance, 2013. www.gov.uk/government/uploads/system/uploads/attachment_data/file/447319/One_Health_Report_July2015.pdf (accessed 13 June 2016).

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Poehling KA, Zhu Y, Tang YW, Edwards K. Accuracy and impact of a point‐of‐care rapid influenza test in young children with respiratory illnesses. Archives of Pediatrics and Adolescent Medicine 2006;160(7):713‐8.

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Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. Journal of Antimicrobial Chemotherapy 2014;69(1):234‐40.

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Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Table 1. List of reviews, interventions, and trials that contributed to the overview with ROBIS assessment

Intervention

Review

RCTs contributed and sample size (n)

ROBIS assessment

Phase 2 domains

Phase 3

1. Study eligibility criteria

2. Identification and selection of studies

3. Data collection and study appraisal

4. Synthesis and findings

5. Risk of bias of review

POCT: C‐reactive protein

Aabenhus 2014

Andreeva 2014 (179)

Cals 2009 (431)

Cals 2010 (258)

Diederichsen 2000 (812)

Little 2013 (4264)

Melbye 1995 (239)

Low risk

Low risk

Low risk

Low risk

Low risk

Huang 2013

Cals 2009 (431)

Cals 2010 (258)

Cals 2011 (330)

Cals 2013* (379)

Diederichsen 2000 (812)

Gonzales 2011 (131)

Melbye 1995 (229)

Low risk

Low risk

Low risk

High risk

Low risk

POCT: rapid viral detection test

Doan 2014

Bonner 2003 (391)

Doan 2009 (200)

Poehling 2006 (300)

Low risk

Low risk

Low risk

Low risk

Low risk

POCT: procalcitonin

Schuetz 2012

Briel 2008 (458)

Burkhardt 2010 (550)

Christ‐Crain 2004 (243)

Christ‐Crain 2006 (302)

Kristoffersen 2009 (210)

Long 2009 (127)

Long 2011 (156)

Schuetz 2009 (1359)

Stolz 2007 (208)

Low risk

Low risk

Low risk

Low risk

Low risk

Educational materials for clinician or decision support, or both

Boonacker 2010

Christakis 2001 (NR)

Wilson 2002 (NR)

Low risk

Low risk

Low risk

High risk

Low risk

Interventions to support shared decision making

Coxeter 2015

Altiner 2007 (2164)

Briel 2006 (552)

Butler 2012 (479,502)

Cals 2009 (431)

Cals 2013* (379)

Francis 2009 (558)

Légaré 2011 (151)

Légaré 2012 (359)

Little 2013 (4264)

Welschen 2004 (1723)

Low risk

Low risk

Low risk

High risk

Low risk

Patient information leaflets to be used by clinician

de Bont 2015

Francis 2009 (558)

Macfarlane 1997 (1014)

Low risk

Low risk

Low risk

High risk

Low risk

Multifaceted interventions

Arnold 2005

Finkelstein 2001 (NR)

Flottorp 2002 (NR)

McIsaac 1998 (NR)

McIsaac 2002 (NR)

Mainous 2000 (NR)

Low risk

Low risk

Low risk

High risk

Low risk

*Cals 2013 is a follow‐up study of the trial reported in Cals 2009.

NR: not reported
POCT: point‐of‐care‐test
RCT: randomised controlled trial

Figuras y tablas -
Table 1. List of reviews, interventions, and trials that contributed to the overview with ROBIS assessment
Ir a la tabla de la revisión
Table 2. Characteristics of excluded reviews

Reason for exclusion

Reviews excluded (n = 15)

Does not include RCTs including parallel‐group, cluster, or factorial RCTs

Petrozzino 2010

Does not include studies that include patients presenting to primary care with acute respiratory infection

Patel 2007

Does not include interventions aimed at health professional with the primary goal of reducing antibiotic prescribing

Andrews 2012; Arroll 2003; Petrozzino 2010; Spurling 2013

Does not investigate the effect of the intervention on antibiotic prescribing compared to usual care or control

Andrews 2012; Arroll 2003; Rausch 2009; Schuetz 2011; Spurling 2013

Duplication of included review

Schuetz 2013 (duplicate of included Cochrane review Schuetz 2012)

Data were not reported at an individual‐study basis.

Gross 2001; van der Velden 2012

No novel coverage in addition to included Cochrane Review

Cooke 2015; Engel 2012 (both fully overlap with Aabenhus 2014 in terms of included trials)

Rated as high risk in ROBIS quality assessment

Ranji 2008; van der Does 2016; Vodicka 2013

RCT: randomised controlled trial
Figuras y tablas -
Table 2. Characteristics of excluded reviews
Ir a la tabla de la revisión
Table 3. Characteristics of included reviews

Review

Date assessed as up‐to‐date

Included RCTs (n)*

Population*

Intervention

Comparison intervention

Primary outcome*

Limitations

Aabenhus 2014

Around January 2014

6

Patients presenting with ARI in general practice

Point‐of‐care tests including C‐reactive protein, procalcitonin, and white blood cell count

Usual care

Number of patients given antibiotic prescription at index consultation and at 28 days' follow‐up

Small number of included studies

Arnold 2005

December 2002

5

Patients presenting with RTI in primary care

Professional interventions in the Cochrane Effective Practice and Organisation

of Care Group. To include: education materials for clinician, educational meetings, local consensus processes, educational outreach visits, local opinion leaders, patient‐mediated interventions, audit and feedback, reminders, marketing, mass media, financial interventions

Usual care or other intervention

Decision to prescribe an antibiotic or not

None reported.

Boonacker 2010

February 2009

2

Children presenting with URTI in primary care

Computerised evidence‐based decision support, development of clinical practice guidelines, and educational materials for clinician

Usual care

Antibiotic prescribing and reduced proportion of prescribed antibiotic courses

Potential for publication bias in search. Cost‐effectiveness not evaluated. Insufficient information to judge risk of bias in some areas

Coxeter 2015

December 2014

9 (reported in 10 papers)

Patients presenting with ARI in primary care

Shared decision making

Usual care or other intervention

Prescription of antibiotics

Intraclass correlation was imputed for 2 studies.

de Bont 2015

April 2014

2

Patients presenting with ARI in general practice

Patient information leaflets (PIL) for use by clinicians in consultations

No PIL

Antibiotic prescribing

Studies were at high risk of bias as blinding to the intervention was not possible. Patients included and outcomes assessed were diverse. No heterogeneity analysis was conducted.

Doan 2014

Around July 2014

3

Children presenting with ARI in the emergency department

Rapid viral diagnosis by testing

No test or test result not made known to clinician

Antibiotic prescribing rate

None reported.

Huang 2013

June 2013

6 (reported in 7 papers)

Patients presenting with ARI in general practice

C‐reactive protein point‐of‐care test

No test or usual care, or both

Antibiotic prescribing at index consultation

Meta‐analysis is based on aggregate data rather than individual‐participant data, so difficult to explore sources of heterogeneity.

Schuetz 2012

2011

9

Adults presenting with ARI in primary care

Strategies to initiate or discontinue antibiotic therapy based on procalcitonin cut‐off ranges

No use of procalcitonin

Initiation of antibiotics

Variation in patient populations/settings and treatment failure was defined differently for each context.

*relevant to this overview
ARI: acute respiratory infection
RCT: randomised controlled trial
RTI: respiratory tract infection
URTI: upper respiratory tract infection

Figuras y tablas -
Table 3. Characteristics of included reviews
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Table 4. Quality of included studies: the proportion of studies within each review judged as at low risk of bias by review authors according to 'Risk of bias' domains

Review ID

Random sequence generation

Allocation concealment

Blinding of participants

Blinding of outcome assessment

Incomplete outcome data

Selective reporting

Other bias

Aabenhus 2014

(6 RCTs)

5 studies*

(83%1)

1 study

(17%)

None

(0%)

5 studies*2

(83%)

6 studies

(100%)

4 studies

(67%)

1 study

(17%)

Arnold 2005

(5 RCTs)

Not reported

1 study

(20%)

Not reported

3 studies

(60%)

2 studies

(20%)

Not reported

Not reported

Boonacker 2010

(2 RCTs)

2 studies

(100%)

1 study

(50%)

2 studies

(100%)

2 studies

(100%)

2 studies

(100%)

2 studies

(100%)

1 study

(34%)

Coxeter 2015

(10 RCTs2)

10 studies

(100%)

7 studies

(70%)

1 study

(10%)

7 studies

(70%)

9 studies

(90%)

10 studies (100%)

7 studies

(70%)

de Bont 2015

(2 RCTs)

1 study

(50%)

2 studies

(100%)

None

(0%)

1 study

(50%)

2 studies

(100%)

2 studies

(100%)

Not reported

Doan 2014

(3 RCTs)

3 studies

(100%)

1 study

(34%)

None

(0%)

None

(0%)

2 studies

(67%)

3 studies

(100%)

3 studies

(100%)

Huang 2013

(7 studies3)

1 study*

(14%)

1 study

(14%)

None

(0%)

None*

(0%)

5 studies

(71%)

7 studies

(100%)

None

(0%)

Schuetz 2012

(9 RCTs)

7 studies

(78%)

4 studies

(33%)

None

(0%)

4 studies

(33%)

9 studies

(100%)

9 studies (100%)

3 studies

(43%)

RCT: randomised controlled trial

*Results differ between reviews where RCTs had significant overlap. Aabenhus 2014 provided more detailed reporting of risk of bias than Huang 2013.
1Percentages report the proportion of RCTs within each review judged as at low risk of bias on the relevant item.
2Aabenhus 2014 reported blinding for primary outcome of antibiotic prescribing separately to blinding for other outcomes.
3Coxeter 2015 and Huang 2013 reported results for 10 and 7 publications of 9 and 6 original RCTs, respectively.

Figuras y tablas -
Table 4. Quality of included studies: the proportion of studies within each review judged as at low risk of bias by review authors according to 'Risk of bias' domains
Ir a la tabla de la revisión
Table 5. Overview of results

Interventions to reduce antibiotic prescribing in the management of acute respiratory infections for patients presenting in primary care

Outcome

Intervention and comparison intervention

Contributing reviews

Relative effect (95% CI) of an antibiotic being prescribed1

Number of participants (RCTs)

Quality of the evidence (GRADE)*

Comments

Change in antibiotic prescriptions for ARI (at consultation)

CRP point‐of‐care test / usual care

Aabenhus 2014

RR 0.78 (0.66 to 0.92)

3284 (6)

Moderate6

CRP point‐of‐care testing probably reduces antibiotic prescribing in general practice compared to usual care. However, CRP testing may have little or no effect on prescribing in emergency departments.

Huang 2013

General practice setting (individual trials reported):

RR 0.57 (0.44 to 0.74)

RR 0.58 (0.45 to 0.74)

Emergency department setting:

RR 1.23 (0.76 to 1.99)

330 (1)

379 (1)

131 (1)

Moderate3*

Low3,6*

Rapid viral diagnosis / usual care

Doan 2014

RR 0.86 (0.61 to 1.22)

891 (3)

Low3,6*

Rapid viral diagnosis may have little or no effect on antibiotic prescribing compared to usual care.

Procalcitonin‐guided management / usual care

Schuetz 2012

General practice setting:

adjusted OR 0.10 (0.07 to 0.14)

Emergency department setting:

adjusted OR 0.34 (0.28 to 0.43)

1008 (2)

2605 (7)

Moderate3

Moderate3

Procalcitonin‐guided management probably reduces antibiotic prescribing in general practice and the emergency department compared to usual care.

Clinician education and decision support / usual care

Boonacker 2010

Difference in behaviour change ‐12% (0.095)

OR 0.60 (0.43 to 0.83)

Not reported (1)

Not reported (1)

Very low3,5,6*

We are uncertain about whether clinician education and decision support reduces antibiotic prescribing compared to usual care.

Patient information leaflets / usual care

de Bont 2015

RR 0.47 (0.36 to 0.64)

RR 1.15 (0.89 to 1.48)

558 (1)

1014 (1)

Very low3,4,6*

We are uncertain as to whether patient information leaflets reduce antibiotic prescribing compared to usual care.

Shared decision making / usual care

Coxeter 2015

No pooled analysis of all trials:

OR 0.44 (0.26 to 0.75)

RR 0.64 (0.49 to 0.84)

adjusted risk difference ‐18.44 (‐27.24 to ‐9.65)

3274 (3)

4623 (2)

481,807 (4)

Moderate3

Shared decision making probably reduces antibiotic prescribing compared to usual care.

Multifaceted interventions

Printed educational materials for clinicians and reminders / usual care

Arnold 2005

Individual trials reported:

OR 0.44 (0.21 to 0.92)

OR 0.57 (0.27 to 1.17)

Not reported (1)

Not reported (1)

Very low3,4,6*

We are uncertain as to whether printed educational materials reduce antibiotic prescribing compared to usual care.

Audit and feedback (with patient education materials) / usual care

Arnold 2005

Difference in behaviour change: ‐7.3% (audit and feedback alone)

Difference in behaviour change: ‐7.2% (audit and feedback with patient materials)

Not reported (1)

Low3,6*

Audit and feedback may reduce antibiotic prescribing compared to usual care.

Educational materials and educational meetings for clinician and patient education materials / usual care

Arnold 2005

Difference in behaviour change:

16% (8% to 23%) (age 3 to 36 months)

Difference in behaviour change:

12% (2% to 21%) (age 36 to 72 months)

Not reported (1)

Low3,6*

Educational materials and meetings may reduce antibiotic prescribing compared to usual care.

Educational materials, computerised decision support, professional development, financial incentive, and patient education materials / usual care

Arnold 2005

Difference in behaviour change: ‐3.0% (P = 0.03)

Not reported (1)

Low3,6*

These interventions may slightly reduce antibiotic prescribing compared to usual care.

Change in antibiotic prescriptions for ARI (within 28 days of consultation)

CRP point‐of‐care test / usual care

Aabenhus 2014

RR 0.80 (0.67 to 0.96)

3284 (6)

Moderate6

CRP point‐of‐care testing probably reduces antibiotic prescribing for up to 28 days following consultation compared to usual care.

Adverse events

CRP point‐of‐care test / usual care

Aabenhus 2014

RR 2.45 (0.65 to 9.19)

4264 (1)

Moderate6

CRP point‐of‐care testing probably results in little or no difference in adverse events compared to usual care.

Symptom duration or severity

CRP point‐of‐care test / usual care

Aabenhus 2014

At 7 days: RR 1.03 (0.93 to 1.14)

At 28 days: RR 0.94 (0.69 to 1.28)

1309 (3)

849 (3)

Moderate6

CRP point‐of‐care testing probably results in little or no difference in symptom duration or severity compared to usual care.

Health‐related quality of life

Procalcitonin‐guided management / usual care

Schuetz 2012

Adjusted difference in days 0.05, ‐0.46 to 0.56, P = 0.854

1008 (2)

Moderate3

Procalcitonin‐guided management probably results in little or no difference in health‐related quality of life compared to usual care.

Patient satisfaction

CRP point‐of‐care test / usual care

Aabenhus 2014

RR 0.79 (0.57 to 1.08)

689 (2)

Moderate6

CRP point‐of‐care testing probably results in little or no difference in patient satisfaction compared to usual care.

Shared decision making / usual care

Coxeter 2015

RR 0.86 (0.57 to 1.30)

1110 (2)

Low3,6

Shared decision making may result in little or no difference in patient satisfaction compared to usual care.

Management failure – reconsultation and treatment failure

CRP point‐of‐care test / usual care

Aabenhus 2014

RR 1.08 (0.93 to 1.27)

5132 (4)

Moderate6

CRP point‐of‐care testing probably results in little or no difference in reconsultation compared with usual care at 28 days' follow‐up.

Shared decision making / usual care

Coxeter 2015

RR 0.87 (0.74 to 1.03)

1860 (4)

Moderate3

Shared decision making probably results in little or no difference in reconsultation compared to usual care.

Patient information leaflets / usual care

de Bont 2015

Individual trials reported:

RR 0.80 (0.52 to 1.21)

RR 0.70 (0.53 to 0.91)

558 (1)

1014 (1)

Very low3,4,6*

We are uncertain as to whether patient intervention leaflets result in a difference in reconsultation compared to usual care.

Rapid viral diagnosis / usual care

Doan 2014

RR 0.86 (0.59 to 1.25)

200 (1)

Low3,6*

Rapid viral diagnostics may result in little or no difference in reconsultation relative to usual care.

Procalcitonin‐guided management / usual care

Schuetz 2012

Treatment failure in general practice2:

adjusted OR 0.95 (0.73 to 1.24)

Treatment failure in emergency department2:

adjusted OR 0.76 (0.61 to 0.95)

1008 (2)

2605 (7)

Moderate3

Procalcitonin‐guided management probably results in little or no difference in treatment failure in general practice compared to normal care.

Procalcitonin‐guided management probably reduces treatment failure in the emergency department compared to usual care.

GRADE quality of evidence and definitions

High quality: Further research is very unlikely to change our confidence in the estimate of effect.

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

Very low quality: Any estimate of effect is very uncertain.

*GRADE criteria were applied retrospectively to outcomes when GRADE was not used by the original review authors.

ARI: acute respiratory infection; CI: confidence interval; CRP: C‐reactive protein; OR: odds ratio; RCT: randomised controlled trial; RR: risk ratio

1Effect estimates are shown as reported in the original reviews. Multiple effect estimates are reported for some outcomes when reviews did not pool data from trials but reported individual trials separately.
2Schuetz 2012 defined treatment failure in primary care as death, hospitalisation, ARI‐specific complications (e.g. empyema for lower ARIs, meningitis for upper ARIs), recurrent or worsening infection, and still having ARI‐associated discomfort at 30 days. Treatment failure in the emergency setting was defined as death, intensive care unit admission, rehospitalisation after index hospital discharge, ARI‐associated complications (e.g. empyema or acute respiratory distress syndrome for lower ARIs), and recurrent or worsening infection within 30 days of follow‐up.
3Quality of evidence was downgraded one level because of risk of bias: inadequate methods of sequence generation, lack of allocation concealment, and/or lack of blinding of participants.
4Quality of evidence was downgraded one level because of inconsistency: heterogeneity in results likely due to differences in the interventions trialled across studies.
5Quality of evidence was downgraded one level because of risk of publication bias: review only reported effective interventions.
6Quality of evidence was downgraded one level due to imprecision because trials included relatively few patients or when the confidence interval showed substantial variation in the effect of the intervention.

Figuras y tablas -
Table 5. Overview of results
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