RE: A Brief Shared Decision-Making Intervention for Acute Respiratory Infections on Antibiotic Dispensing Rates in Primary Care: A Cluster Randomized Trial

You can lead a horse to water …

This study by Hoffmann et al, in Australia, is the latest in a very long line of studies which have shown that provision of educational resources for family medicine practitioners, and potentially for their patients, commonly has no effect on the rates of antibiotic prescribing for self-limited respiratory tract infections. The reason that the educational resources had no overall effect in this study is not surprising. One third of the doctors never viewed the resources, and presumably never shared them with their patients. This was not a reflection on the quality of the resources: on acute otitis media, bronchitis and sore throat. Those doctors who did read the resources had a significant, but small, increase in their knowledge of these common conditions, and the relative benefits and harms of antibiotic “treatment”.

However, while the efforts of concerned academics to find ways to help family practitioners to reduce their inappropriate antibiotic prescribing seem largely futile, a society wide change is underway in most developed nations. Community antibiotic dispensing is in decline, presumably as the result of increased public awareness that we have overused these medicines for decades, and that we would be wise to use them less profligately in the future. Efforts to further increase public knowledge about common infections may more rapidly reduce inappropriate community antibiotic use than efforts to improve the knowledge of their doctors.