TY - JOUR A1 - Gágyor, Ildikó A1 - Greser, Alexandra A1 - Heuschmann, Peter A1 - Rücker, Viktoria A1 - Maun, Andy A1 - Bleidorn, Jutta A1 - Heintze, Christoph A1 - Jede, Felix A1 - Eckmanns, Tim A1 - Klingeberg, Anja A1 - Mentzel, Anja A1 - Schiemann, Guido T1 - REDuction of Antibiotic RESistance (REDARES) in urinary tract infections using treatments according to national clinical guidelines: study protocol for a pragmatic randomized controlled trial with a multimodal intervention in primary care JF - BMC Infectious Diseases N2 - Background: Urinary tract infections (UTIs) are a common cause of prescribing antibiotics in family medicine. In Germany, about 40% of UTI-related prescriptions are second-line antibiotics, which contributes to emerging resistance rates. To achieve a change in the prescribing behaviour among family physicians (FPs), this trial aims to implement the guideline recommendations in German family medicine. Methods/design: In a randomized controlled trial, a multimodal intervention will be developed and tested in family practices in four regions across Germany. The intervention will consist of three elements: information on guideline recommendations, information on regional resistance and feedback of prescribing behaviour for FPs on a quarterly basis. The effect of the intervention will be compared to usual practice. The primary endpoint is the absolute difference in the mean of prescribing rates of second-line antibiotics among the intervention and the control group after 12 months. To detect a 10% absolute difference in the prescribing rate after one year, with a significance level of 5% and a power of 86%, a sample size of 57 practices per group will be needed. Assuming a dropout rate of 10%, an overall number of 128 practices will be required. The accompanying process evaluation will provide information on feasibility and acceptance of the intervention. Discussion: If proven effective and feasible, the components of the intervention can improve adherence to antibiotic prescribing guidelines and contribute to antimicrobial stewardship in ambulatory care. KW - antibiotic resistance KW - urinary tract infections KW - guideline adherence KW - multimodal KW - family physicians KW - primary care Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-264725 VL - 21 ER - TY - JOUR A1 - Schmiemann, Guido A1 - Greser, Alexandra A1 - Maun, Andy A1 - Bleidorn, Jutta A1 - Schuster, Angela A1 - Miljukov, Olga A1 - Rücker, Viktoria A1 - Klingeberg, Anja A1 - Mentzel, Anja A1 - Minin, Vitalii A1 - Eckmanns, Tim A1 - Heintze, Christoph A1 - Heuschmann, Peter A1 - Gágyor, Ildikó T1 - Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial JF - BMJ N2 - Objectives To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women. Design Parallel, cluster randomised, controlled trial. Setting General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022. Participants General practitioners from 128 randomly assigned practices. Interventions Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention. Main outcome measures Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes. Results 110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was −0.13 (95% confidence interval −0.21 to −0.06, P<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of −0.08 (95% confidence interval −0.15 to −0.02, P<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups. Conclusions The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women. Trial registration German Clinical Trials Register (DRKS), DRKS00020389 KW - urinary tract infections KW - women KW - multimodal intervention KW - second line antibiotics Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-349395 SN - 1756-1833 VL - 383 ER -