Long-term effects of a multifaceted antimicrobial stewardship program, with audit and feedback, on acute sore throat in primary care – A randomized controlled trial

OBJECTIVES: Acute sore throat is a common reason for antibiotic prescribing. Physicians often experience uncertainty in managing these, and guideline adherence remains suboptimal. There is a need for antimicrobial stewardship programmes (ASPs) for this setting. The objective was to evaluate if a multifaceted ASP could improve long-term guideline adherence. METHODS: This was a randomized controlled trial in primary care centres in Sweden. Centres were randomly assigned to intervention or control group. The 6-month intervention comprised of multiple meetings with practitioners to reflect on the current sore throat guideline, didactic patient case discussions, local quality improvement initiatives and repeated individual audits and feedback using laboratory and prescribing data for their patients. The primary outcome was the change in the proportion of antibiotic-prescribed cases with a positive rapid antigen detection test for Streptococcus pyogenes. RESULTS: At baseline, approximately two-thirds of pharyngotonsillitis cases were managed in accordance with the Swedish national guideline. No significant change in guideline adherence was observed in either group at 6, 12 or 18 months from baseline. CONCLUSION: The addition of a 6-month multifaceted ASP did not improve long-term guideline adherence for these patients. Alternative approaches need to be explored to support sustainable changes in prescribing behaviour.