Digital Stewardship Cut Antibiotic Use for ARIs in Rural Facilities

Key Takeaways

• Antibiotic prescribing was substantially lower in intervention consultations, with adjusted analyses favoring the stewardship program.
• The intervention was a comprehensive, digitally enabled stewardship program, while control facilities continued usual care without additional inputs.
• Thirty-day hospitalization for respiratory illness or sepsis did not differ between groups, with no evidence of increased harm during that period.

A digitally enabled antibiotic stewardship program was associated with an adjusted 39 percentage point reduction in antibiotic prescribing for acute respiratory infection consultations in a pragmatic cluster randomized trial across 34 township hospitals in two rural counties of Guangdong, China. The trial compared the program with usual care during routine primary care delivery and evaluated prescribing patterns for acute respiratory infections in everyday practice.

The study was a pragmatic cluster randomized controlled trial conducted in 34 township hospitals in two rural counties of Guangdong, China. Investigators analyzed 97,239 eligible acute respiratory infection consultations during the 12-month implementation period from 1 March 2020 to 28 February 2021. The digitally enabled stewardship program combined physician training and guidelines, electronic medical record–embedded evidence-based guidance with point-of-care prompts, monthly prescribing peer review feedback, and smartphone-app patient education. Control hospitals received usual care with no inputs.

Inappropriate use of antibiotics for acute respiratory infections is a major challenge driving antimicrobial resistance in primary care in low- and middle-income countries. The primary outcome was whether a consultation resulted in any antibiotic prescription. Antibiotics were prescribed in 26% of intervention consultations, or 14,521 of 54,799, versus 71% of control consultations, or 30,340 of 42,440. The adjusted risk difference was minus 39 percentage points, with a 95% confidence interval from minus 47 to minus 29 and P less than 0.001.

For short-term safety, 30-day hospitalization for respiratory illness or sepsis did not differ between groups. The adjusted risk difference for that outcome was 0.2 percentage points, with a 95% confidence interval from minus 0.3 to 0.6. The program was associated with lower antibiotic prescribing without a detectable difference in 30-day hospitalization outcomes.