Integrating Infectious Disease Experts into Primary Care Antibiotic Stewardship: A Multicentre, Cluster-Randomised, Outcome-Assessor-Blinded Trial
In brief
ID expert support reduced inadequate antibiotic prescribing by 14 percentage points
In six Catalonian primary care centers, clinics with infectious disease expert support had fewer inadequate prescriptions at the intervention's end than clinics with standard stewardship: 38.8% versus 52.9%. Unnecessary prescriptions also fell, but overall antibiotic consumption rose in both groups, with no significant difference between them; whether the improvement in prescribing quality translates into better patient outcomes remains unclear.
- Journal
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (Q1)
- Published
- 8 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Mar Ronda, Ariadna Padullés, Jordi Carratalà, Cinta Estrada, Ana Lérida, Fe Tubau, et al.
- PMID
- 42849833
- DOI
- 10.1016/j.cmi.2026.09.034
Why clinicians should know about it
- Picked for Family Practice (paper of the day, 11 October 2026): ID experts in primary‑care antibiotic stewardship
Abstract
OBJECTIVE: To assess the impact of integrating infectious disease (ID) experts into primary care antimicrobial stewardship (AMS) programmes on antibiotic consumption and prescribing adequacy for upper respiratory tract infections (URTIs) and urinary tract infections (UTIs). METHODS: A multicentre, cluster-randomised trial across six primary care centres in Catalonia, Spain. All centres implemented a standard AMS programme, with three randomised to an advanced AMS (receiving ID expert support via a telephone helpline and biweekly meetings). The primary endpoint was total antibiotic consumption (defined daily doses per 1,000 inhabitants per day [DID]). Secondary endpoints included unnecessary and inadequate prescriptions, and 30-day reconsultations or hospitalisations, evaluated through point-prevalence surveys in patients aged over 14 years with URTI or UTI. RESULTS: Between October 2021 and March 2023, overall antibiotic consumption increased from 7.08 (SD 1.29) to 7.79 (SD 1.65) DID (mean difference +0.71 [95% CI 0.13;1.28]). This rise was lower under advanced AMS, from 7.16 (SD 1.33) to 7.56 (SD 1.44) DID (+0.40 [95% CI -0.40;1.20]) than standard AMS, from 7.00 (SD 1.29) to 8.01 (SD 1.82) DID (+1.01 [95% CI 0.15;1.88]). During the intervention, Poisson regression showed a 4% monthly DID increase (IRR 1.04 [95% CI 1.01;1.06]), without intergroup differences (IRR 0.95 [95% CI 0.19;4.74]). Across 1,389 URTI/UTI episodes, 25.0% of prescriptions were unnecessary and 50.3% of indicated treatments were inadequate. By intervention end, advanced AMS reduced unnecessary (21.2% vs 28.3%; OR 0.68 [95% CI 0.51;0.91]) and inadequate prescriptions (38.8% vs 52.9%; OR 0.54 [95% CI 0.36;0.81]) compared with standard AMS. Reconsultations or hospitalisations showed no significant differences. CONCLUSION: Integrating ID experts into primary care AMS did not demonstrate a statistically significant reduction in total antibiotic use. However, the data suggest a positive impact on prescribing quality without compromising patient safety. Health policymakers should consider embedding ID expertise within primary care AMS frameworks.
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.