Article type
Year
Abstract
Objective: To document the impact of a Cochrane Systematic Review on National and International Policy and Practice.
Methods: Broad search strategies were used to search electronic databases and the internet for relevant information. Hand searching of medical popular press publication was undertaken. Two authors of the review were contacted.
Results: In 1996, a Cochrane review entitled "Antibiotics for Acute Otitis Media" (Glasziou, Hayem, Del Mar and Sanders) was published in the Cochrane Library. At that time in Australia approximately 26.5 million prescriptions of antibiotics were written annually, equal to 24.7 defined daily doses (DDDs)/1000 population/day. For Upper Respiratory Tract Infections (URTI's), antibiotics were prescribed for between 57-73% of all new cases presented to general practitioners. The Antibiotics for Acute Otitis Media review found that while the course of acute otitis media may be shortened by antibiotics, most cases will generally subside without complications. This research, combined with other studies, generated a change in the Australian Antibiotic Guidelines in 1996 - 1997. The guidelines were modified to state that in URTI the use of antibiotics is not routinely indicated. By 1998/99, antibiotic use had dropped to 23.3 million prescriptions or approximately 22 DDDs/1000/day. Antibiotics were being prescribed in only 43-46% of new URTI cases reported to doctors with 75% of cases dealt with in accordance with the Antibiotic Guidelines. The Antibiotics for Acute Otitis Media review, along with other reviews and meta-analyses, also formed the basis for the National Prescribing Service's (NPS) position on antibiotics in acute otitis media. The treatment of URTI's with antibiotics has become a focal point of the NPS's program targeted at prescribers. The Cochrane Consumer Network, which disseminates health care information to consumers published information on acute middle ear infections for children and babies in its "Hot Topics" section. The majority of information for this was obtained from the Anitbiotics for Acute Otitis Media review. Antibiotic guidelines in the United States have also changed in line with the evidence presented in this review. Further programs and projects have developed. C. Cates in the UK read the review and undertook a study of a delayed antibiotic prescription program for acute otitis media. This showed a reduction in antibiotic usage. A randomised control trial (Little et al, 2001) was conducted with the authors concluding that a wait and see approach to antibiotic prescription for acute otitis media is feasible.
Conclusion: Systematic summarising of high quality research has the potential to influence practice and beliefs at a patient, national, and international level. The review, Antibiotics for Acute Otitis Media, in conjunction with other research and through appropriate dissemination was followed by a reduction in antibiotic prescribing in Australia. The limited data fails to provide evidence proving a strong association between review and the change in practice. National (Australian) and International (United States) guidelines have changed with the accumulation of evidence surrounding this review.
Methods: Broad search strategies were used to search electronic databases and the internet for relevant information. Hand searching of medical popular press publication was undertaken. Two authors of the review were contacted.
Results: In 1996, a Cochrane review entitled "Antibiotics for Acute Otitis Media" (Glasziou, Hayem, Del Mar and Sanders) was published in the Cochrane Library. At that time in Australia approximately 26.5 million prescriptions of antibiotics were written annually, equal to 24.7 defined daily doses (DDDs)/1000 population/day. For Upper Respiratory Tract Infections (URTI's), antibiotics were prescribed for between 57-73% of all new cases presented to general practitioners. The Antibiotics for Acute Otitis Media review found that while the course of acute otitis media may be shortened by antibiotics, most cases will generally subside without complications. This research, combined with other studies, generated a change in the Australian Antibiotic Guidelines in 1996 - 1997. The guidelines were modified to state that in URTI the use of antibiotics is not routinely indicated. By 1998/99, antibiotic use had dropped to 23.3 million prescriptions or approximately 22 DDDs/1000/day. Antibiotics were being prescribed in only 43-46% of new URTI cases reported to doctors with 75% of cases dealt with in accordance with the Antibiotic Guidelines. The Antibiotics for Acute Otitis Media review, along with other reviews and meta-analyses, also formed the basis for the National Prescribing Service's (NPS) position on antibiotics in acute otitis media. The treatment of URTI's with antibiotics has become a focal point of the NPS's program targeted at prescribers. The Cochrane Consumer Network, which disseminates health care information to consumers published information on acute middle ear infections for children and babies in its "Hot Topics" section. The majority of information for this was obtained from the Anitbiotics for Acute Otitis Media review. Antibiotic guidelines in the United States have also changed in line with the evidence presented in this review. Further programs and projects have developed. C. Cates in the UK read the review and undertook a study of a delayed antibiotic prescription program for acute otitis media. This showed a reduction in antibiotic usage. A randomised control trial (Little et al, 2001) was conducted with the authors concluding that a wait and see approach to antibiotic prescription for acute otitis media is feasible.
Conclusion: Systematic summarising of high quality research has the potential to influence practice and beliefs at a patient, national, and international level. The review, Antibiotics for Acute Otitis Media, in conjunction with other research and through appropriate dissemination was followed by a reduction in antibiotic prescribing in Australia. The limited data fails to provide evidence proving a strong association between review and the change in practice. National (Australian) and International (United States) guidelines have changed with the accumulation of evidence surrounding this review.