Guidelines and antibiotics: an experience of improvement in Reggio Emilia Primary Care

Key words: Paediatrics, Antibiotic, Prescriptions, Pharmacoepidemiology

Background - International and Italian guidelines consistently recommend amoxicillin as first line antibiotic for bacterial respiratory infections in children. However, Italian data on antibiotic prescriptions still show inappropriateness. The province of Reggio Emilia, and in particular the district of Scandiano, shows a better scenario in terms of pertinence compared to other contexts.
Objectives - To evaluate the effect of an intervention of systematic audit and feedback among paediatricians working in the district of Scandiano on pertinence of antibiotic prescriptions in comparison with other districts of Reggio Emilia that did not implement this intervention.
Materials and methods - The study took place in the district of Scandiano (AUSL of Reggio Emilia). Paediatricians (PLS) of the district systematically met to discuss prescription choices in comparison with the literature.
Results - From 2011 to 2015 in most of the districts of the Reggio Emilia AUSL was a clear reduction in terms of total antibiotic prescriptions, an increase in the prescriptions of amoxicillin, with parallel decrease in amoxicilline-clavulanate and cephalosporin, and a modest decline in macrolides. The district of Scandiano stands out for being the district with the most appropriate use of antibiotics and with the lowest variability of prescriptions among colleagues.
Conclusion - The work among equals on personal data of prescription and on evidence from the literature carried out by the paediatricians of the district of Scandiano led to a significant improvement in individual prescription behaviour and to a very low variability index in the use of the main classes of antibiotics among all colleagues.