Adding to the mix: The impact of antibiotic prescribing feedback at a health-system level in Switzerland

Reviewed by Jose Lucar, MD; The George Washington University

Effective system-wide strategies are needed to improve outpatient antibiotic prescribing in the primary care setting. In this pragmatic clinical trial among over 3,000 primary care physicians and pediatricians in Switzerland who were in the top 75th percentile of antibiotic prescribers, clinicians were randomized 1:1 to receive either quarterly antibiotic prescribing feedback with peer benchmarking (intervention group) or no intervention (control group) for 2 years (2018-2019). 

The authors found an overall 4% relative increase in antibiotic prescribing from the baseline year to the second year of the intervention and no difference in the median annual antibiotic prescribing rate per 100 consultations between the groups. The authors discuss that delays in delivering data for feedback, lack of diagnosis-level prescribing appropriateness data, and a concurrent rise of influenza-like illnesses and invasive H. influenzae infections during the study period may have limited the impact of the intervention. An accompanying editorial highlights that, in order to be effective, antibiotic prescribing feedback should be as uncomplicated and clear as possible, and that researchers should include behavioral scientists in designing interventions. 


  • Aghlmandi S, Halbeisen FS, Saccilotto R, et al. Effect of Antibiotic Prescription Audit and Feedback on Antibiotic Prescribing in Primary Care: A Randomized Clinical Trial. JAMA Intern Med. 2023 Mar 1;183(3):213-220.
  • Linder JA, Fox CR. Simplicity Matters—Overengineering Feedback Can Be Counterproductive. JAMA Intern Med. 2023;183(3):220–222. doi:10.1001/jamainternmed.2022.6528
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