Feldmeier Gregor, Löffler Christin, Altiner Attila, Wollny Anja, Garbe Katharina, Kronsteiner Dorothea, Köppen Martina, Szecsenyi Joachim, Leyh Mirko, Voss Arwed, Kamradt Martina, Poß-Doering Regina, Wensing Michel, Kaufmann-Kolle Petra
Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany.
Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany.
Antibiotics (Basel). 2023 May 4;12(5):850. doi: 10.3390/antibiotics12050850.
Within primary care, acute respiratory tract infections (ARTIs) are the most common reason for prescribing antibiotics. The aim of the CHANGE-3 study was to investigate how antibiotic prescribing for non-complicated ARTIs can be reduced to a reasonable level. The trial was conducted as a prospective study consisting of a regional public awareness intervention in two regions of Germany and a nested cluster randomised controlled trial (cRCT) of a complex implementation strategy. The study involved 114 primary care practices and comprised an intervention period of six winter months for the nested cRCT and two times six winter months for the regional intervention. The primary outcome was the percentage of antibiotic prescribing for ARTIs between baseline and the two following winter seasons. The regression analysis confirmed a general trend toward the restrained use of antibiotics in German primary care. This trend was found in both groups of the cRCT without significant differences between groups. At the same time, antibiotic prescribing was higher in routine care (with the public campaign only) than in both groups of the cRCT. With regard to secondary outcomes, in the nested cRCT, the prescribing of quinolones was reduced, and the proportion of guideline-recommended antibiotics increased.
在初级医疗保健中，急性呼吸道感染（ARTIs）是开具抗生素处方最常见的原因。CHANGE-3研究的目的是调查如何将非复杂性急性呼吸道感染的抗生素处方减少到合理水平。该试验作为一项前瞻性研究开展，包括在德国两个地区进行的区域公众意识干预以及一项复杂实施策略的嵌套整群随机对照试验（cRCT）。该研究涉及114家初级医疗保健机构，嵌套cRCT的干预期为六个冬季月份，区域干预为两个六个冬季月份。主要结局是急性呼吸道感染抗生素处方在基线水平与随后两个冬季季节之间的比例。回归分析证实了德国初级医疗保健中抗生素使用受限的总体趋势。在cRCT的两组中均发现了这一趋势，两组之间无显著差异。同时，常规护理（仅开展公众宣传活动）中的抗生素处方高于cRCT的两组。关于次要结局，在嵌套cRCT中，喹诺酮类药物的处方减少，指南推荐抗生素的比例增加。
