Background This systematic review evaluates the effect of audit and feedback (A&F) interventions targeting antibiotic prescribing in primary care and examines factors that may explain the variation in effectiveness. Methods Randomized controlled trials (RCTs) involving A&F interventions targeting antibiotic prescribing in primary care were included in the systematic review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ClinicalTrials.gov were searched up to May 2024. Trial, participant, and intervention characteristics were extracted independently by two researchers. Random effects meta-analyses of trials that compared interventions with and without A&F were conducted for four outcomes: 1) total antibiotic prescribing volume; 2) unnecessary antibiotic initiation; 3) excessive prescription duration, and 4) broad-spectrum antibiotic selection. A stratified analysis was also performed based on study characteristics and A&F intervention design features for total antibiotic volume. Results A total of 56 RCTs fit the eligibility criteria and were included in the meta-analysis. A&F was associated with an 11% relative reduction in antibiotic prescribing volume (N=21 studies, rate ratio [RR]=0.89; 95% confidence interval [CI] 0.84, 0.95; I2=97); 23% relative reduction in unnecessary antibiotic initiation (N=16 studies, RR=0.77; 95%CI 0.68, 0.87; I2=72); 13% relative reduction in prolonged duration of antibiotic course (N=4 studies, RR=0.87 95%CI 0.81, 0.94; I2=86); and 17% relative reduction in broad-spectrum antibiotic selection (N=17 studies, RR=0.83 95%CI 0.75, 0.93; I2=96). Discussion A&F interventions reduce antibiotic prescribing in primary care. However, heterogeneity was substantial, outcome definitions were not standardized across the trials, and intervention fidelity was not consistently assessed. Funding Canadian Institutes of Health Research FRN 173704 Registration Prospero (CRD42022298297)

中文翻译：

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初级保健中抗生素处方的审计和反馈干预：系统评价和荟萃分析


背景 本系统综述评估了初级保健中针对抗生素处方的审计和反馈 （A&F） 干预措施的效果，并检查了可能解释有效性差异的因素。方法 系统评价纳入涉及初级保健中针对抗生素处方的 A&F 干预措施的随机对照试验 （RCT）。检索了截至 2024 年 5 月的 Cochrane 对照试验中心注册库、MEDLINE、EMBASE、CINAHL 和 ClinicalTrials.gov。试验、受试者和干预特征由两名研究人员独立提取。对比较有和没有 A&F 的干预措施的试验进行随机效应荟萃分析，以评估 4 个结局： 1） 抗生素处方总量;2） 不必要的抗生素启动;3） 处方持续时间过长，以及 4） 广谱抗生素选择。还根据研究特征和抗生素总体积的 A&F 干预设计特征进行了分层分析。结果 共有 56 项 RCT 符合纳入标准并纳入 meta 分析。A&F 与抗生素处方量相对减少 11% 相关 （N=21 项研究，比率比 [RR] =0.89;95% 置信区间 [CI] 0.84、0.95;I2=97）;不必要的抗生素开始相对减少 23%（N=16 项研究，RR=0.77;95% CI 0.68,0.87;I2=72）;抗生素疗程延长的持续时间相对减少 13%（N=4 项研究，RR=0.87,95% CI 0.81,0.94;I2=86）;广谱抗生素选择相对减少 17%（N=17 项研究，RR=0.83,95% CI 0.75,0.93;I2=96）。讨论 A&F 干预措施减少了初级保健中的抗生素处方。 然而，异质性很大，试验的结局定义没有标准化，干预保真度没有得到一致的评估。资助加拿大卫生研究院 FRN 173704 注册 Prospero （CRD42022298297）