Implementation, adoption and impact of clinical decision support system for antibiotic prescribing in primary care: a systematic review
In brief
Decision-support tools lowered antibiotic prescribing in 17 of 32 primary-care studies
A systematic review of 40 studies found that clinical decision-support systems, often embedded in electronic health records, were used in over half of consultations in only five investigations, yet 17 of 32 outcome studies reported a drop in overall antibiotic use. Adoption varied widely and barriers such as alert fatigue and workflow disruption limit broader rollout, leaving scalability uncertain.
- Journal
- The Journal of antimicrobial chemotherapy (Q1)
- Published
- 1 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Racha Ibrahim, Claire Durand, Monsey Macleod, François-Xavier Lescure, Claire Amaris Hobson, Esmita Charani, et al.
- PMID
- 42678035
- DOI
- 10.1093/jac/dkag276
Why clinicians should know about it
- Picked for Microbiology (medical) (top studies of the week, 6 September 2026): CDSS systematic review for antibiotic prescribing, not microbiology
- Picked for Family Practice (top studies of the week, 6 September 2026): CDSS improves guideline antibiotic prescribing in primary care
Abstract
BACKGROUND: Clinical decision support systems (CDSS), computerized tools that assist clinicians in making guideline-based decisions, may support antimicrobial prescribing in primary care. METHODS: Studies on CDSS implementation, use and outcomes in primary care on PubMed/MEDLINE and Embase were included up to June 2025. RESULTS: Of the 64 full-text articles assessed, 40 were included. Most were multicentric (n = 33, 82.5%) and conducted in high-income countries (n = 33, 82.5%), and 19 were randomized controlled trials (47.5%). CDSS mainly targeted respiratory infections (n = 24, 60%) and were integrated into electronic health records in 24 studies (60%). Implementation strategies were assessed in 19 studies with almost all using a multimodal approach, most commonly involving modification of health record systems (n = 18, 45%) and audit and feedback (n = 17, 42.5%). Adoption was highly variable: among the 11 studies reporting use, CDSS were used in more than half of consultations in only five studies. Among the 32 studies assessing clinical outcomes, 17 reported reduced overall antibiotic prescribing. Barriers to CDSS use included perceptions of redundancy, time consumption, language limitations, alert fatigue, technical issues and concerns about negative impacts on patient-doctors trust. CONCLUSION: CDSS may improve guideline-concordant antibiotic prescribing in primary care, but wide variability in implementation and real-world adoption limits generalizability and scalability.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.