# Impact of multifaceted clinical decision support and education on antibiotic duration in outpatients with respiratory tract infections in Saudi Arabia: a prospective pre- and postimplementation study

## TL;DR

A study in Saudi Arabia found that combining decision support tools and education reduced antibiotic use duration for respiratory infections in outpatients.

## Contribution

A multifaceted antimicrobial stewardship initiative was implemented and evaluated in an outpatient setting for the first time in Saudi Arabia.

## Key findings

- Antibiotic days of therapy per 1,000 outpatient visits decreased from 131 to 50 after the intervention.
- Adherence to recommended antibiotic duration improved from 49.7% to 56.3% following the intervention.

## Abstract

Prolonged antibiotic therapy is associated with an increased risk of antimicrobial resistance and adverse events. We evaluated the implementation of a multifaceted antimicrobial stewardship (ASP) initiative aimed at reducing antibiotic duration for respiratory tract infections (RTIs) in outpatient settings.

Quasi-experimental study.

Academic medical center in Riyadh, Saudi Arabia.

Patient with RTIs in outpatient settings

A multifaceted ASP intervention—including a clinical decision support tool and an educational session—was implemented to guide physicians in prescribing the shortest effective duration of oral antibiotics. We compared antibiotic utilization and adherence to evidence-based duration prescribing in a preintervention phase (June 2021–December 2021) and a postintervention phase (January 2022–June 2022) .

We included 2320 patients in our study, of which 1359 were in the preintervention period and 961 in the postintervention period. Following implementation of the multifaceted stewardship initiative, the days of therapy (DOT) per 1,000 outpatient visits decreased from 131 to 50 and the mean duration of antibiotic therapy declined from 6.4 to 6.0 days (p < 0.001). Adherence to the recommended duration improved, with the percentage of prescriptions meeting recommended duration increasing from 49.7% to 56.3% (p = 0.002).

The multifaceted ASP initiative can reduce unnecessary antibiotic exposure and improve the adherence to the recommended duration.