Effects of a comprehensive antibiotic stewardship program on antibiotic prescribing for acute respiratory infections in rural facilities: a cluster randomized trial
Summary
Antimicrobial resistance is driven by inappropriate use of antibiotics for acute respiratory infections (ARIs), which is a major challenge in primary care in low- and middle-income countries. Here we conducted a pragmatic, cluster randomized controlled trial in 34 township hospitals in two rural counties of Guangdong, China, to evaluate whether a digitally enabled stewardship program could reduce antibiotic prescribing. The intervention combined training and guidelines for doctors; concise
Content
# Effects of a comprehensive antibiotic stewardship program on antibiotic prescribing for acute respiratory infections in rural facilities: a cluster randomized trial
*Published: 2026 Mar*
Antimicrobial resistance is driven by inappropriate use of antibiotics for acute
respiratory infections (ARIs), which is a major challenge in primary care in
low- and middle-income countries. Here we conducted a pragmatic, cluster
randomized controlled trial in 34 township hospitals in two rural counties of
Guangdong, China, to evaluate whether a digitally enabled stewardship program
could reduce antibiotic prescribing. The intervention combined training and
guidelines for doctors; concise, evidence-based guidelines embedded in the
electronic medical record with point-of-care prompts; monthly prescribing peer
review feedback for doctors; and patient education delivered through a
smartphone app. Control is usual care with no inputs. During the 12-month
implementation period (1 March 2020 to 28 February 2021), we analyzed 97,239
eligible consultations for ARIs. The primary outcome was whether a consultation
resulted in any antibiotics being prescribed. This outcome was met: antibiotics
were prescribed in 26% (14,521/54,799) of intervention consultations compared to
71% (30,340/42,440) of control consultations, yielding an adjusted risk
difference of -39 percentage points (95% confidence interval: -47 to -29;
P < 0.001). There was no evidence of increased harm, as 30-day hospitalization
rates for respiratory illness or sepsis did not differ between groups (adjusted
risk difference, 0.2 percentage points; 95% confidence interval: -0.3 to 0.6). A
comprehensive stewardship program can substantially reduce inappropriate
antibiotic prescribing for ARIs in rural primary care facilities in China
without compromising patient safety. Trial registration: ISRCTN96892547 .
DOI: 10.1038/s41591-026-04222-y