This before-after study was aimed to evaluate the effect of two interventions on lowering the prescription of antibiotics in lower respiratory tract infections (LRTI) in Spain.

General practitioners (GPs) recorded all cases with LRTIs during 3-week periods before and after an intervention, in 2008 and 2009.  Two types of intervention were considered: full intervention (FIG) consisting of discussion sessions on the results of the first audit, courses for GPs, guidelines, patient information leaflets, workshops on rapid tests and use of the C-reactive protein (CRP) test.  GPs in the partial intervention group (PIG) underwent all the above interventions except for the workshop on rapid tests and they did not have access to CRP testing.  A multilevel logistic regression analysis was performed with the prescribing of an antibiotic as the dependent variable.

210 physicians were assigned to FIG and 70 to PIG.  In 2009, 58 new physicians were included as a control group.  5385 LRTIs were recorded.  Compared with the control group the odds ratio of antibiotic prescription after the intervention in the PIG was 0.42 (95% CI, 0.22 to 0.82), and 0.22 (95% CI, 0.12 to 0.38) in the FIG.

The intervention led to a reduction in the prescribing of antibiotics, particularly when CRP testing was available.