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Antimicrobial resistance (AMR), considered one of the greatest global threats by the WHO, justifies the development of initiatives to promote appropriate antibiotic use-especially in primary care, where most antibiotics in France are prescribed and where misuse remains common.
We are proposing a cluster-randomized controlled trial to evaluate the effectiveness of a bimodal intervention combining: (1) improved communication about the circulation of respiratory viruses, and (2) strengthened collaborative practices between general practitioners and pharmacists through a multidisciplinary protocol aimed at verifying that prescribed treatment durations comply with guidelines.
The study will include six primary care practices (24 physicians), with three practices in each study arm.
The aim of this project is to assess whether the bimodal intervention can reduce the duration of antibiotic treatments for upper and lower respiratory tract infections. The first component (a "viral infection prescription" tool) focuses on reducing unnecessary treatment initiation, while the second (pharmacist-led review) aims to shorten excessive prescription durations.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | No Intervention | The primary care practices in the control group do not receive any intervention and continue patient management according to their usual practices. | |
| Intervention group | Experimental | For the intervention group, two planned interventions will be planed and applied to the primary care practices:
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Antibiotic prescribing according to guidelines | Other | If necessary, the general practitioner prescribes antibiotics to patients consulting for an upper or lower respiratory tract infection, according to the guidelines. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of antibiotic treatment days prescribed for upper and lower respiratory tract infections. | The primary outcome of the study will be the number of antibiotic treatment days prescribed for upper and lower respiratory tract infections. This outcome is a composite measure reflecting the impact of both interventions. Antibiotic duration will be assessed by running a query in the electronic medical record system of the participating primary care practices. The primary outcome will be evaluated at the baseline. | The primary outcome is measured at the time of prescription (i.e. at the baseline) |
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Inclusion Criteria:
- Patient seen in consultation for an upper or lower respiratory tract infection (Angina, Acute bronchiolitis, Acute bronchitis, COPD exacerbation (AECOPD), Laryngitis, Acute otitis media (AOM), Serous or congestive otitis, Viral respiratory infection (e.g., influenza), Community-acquired pneumonia (CAP), Rhinitis / Nasopharyngitis, Acute sinusitis)
Exclusion Criteria:
- Patient under legal protection
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Renaud Verdon, PU-PH | Contact | +33231064709 | verdon-r@chu-caen.fr | |
| Pascal Thibon, PH | Contact | +33231065150 | thibon-p@chu-caen.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU CAEN Normandie | Recruiting | Caen | 14000 | France |
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| ID | Term |
|---|---|
| D000787 | Angina Pectoris |
| D001991 | Bronchitis |
| D007827 | Laryngitis |
| D010033 | Otitis Media |
| D007251 | Influenza, Human |
| D000098968 | Community-Acquired Pneumonia |
| D012220 | Rhinitis |
| D009304 | Nasopharyngitis |
| D012141 | Respiratory Tract Infections |
| ID | Term |
|---|---|
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
| D002637 | Chest Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D007239 | Infections |
| D001982 | Bronchial Diseases |
| D012140 | Respiratory Tract Diseases |
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D007818 | Laryngeal Diseases |
| D010038 | Otorhinolaryngologic Diseases |
| D010031 | Otitis |
| D004427 | Ear Diseases |
| D009976 | Orthomyxoviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D017714 | Community-Acquired Infections |
| D011014 | Pneumonia |
| D009668 | Nose Diseases |
| D010612 | Pharyngitis |
| D009302 | Nasopharyngeal Diseases |
| D010608 | Pharyngeal Diseases |
| D009057 | Stomatognathic Diseases |
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