***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Increased antibiotic use for outpatient illnesses has been identified as an important determinant of the recent rise in antibiotic resistance among common respiratory pathogens . Efforts to reduce the inappropriate use will need to be evaluated against current trends in the outpatient use of antibiotics . OBJECTIVES To examine national trends in the use of antibiotics by primary care physicians in the care of adult patients with cough and identify patient factors that may influence antibiotic use for these patients . METHODS This study was based on a serial analysis of results from all National Ambulatory Medical Care Surveys beginning in 1980 ( when therapeutic drug use was first recorded ) to 1994 ( the most recent survey year available ) . These surveys are a r and om sampling of visits to US office-based physicians in 1980 , 1981 , 1985 , and annually from 1989 - 1994 . Eligible visits included those by adults presenting to general internists , family practitioners , or general practitioners with a chief complaint of cough . A total of 3416 visits for cough were identified over the survey years . Survey results were extrapolated , based on sampling weights in each year , to project national rates of antibiotic use for patients with cough . Additional analyses examined the rates of antibiotic use stratified by patient age , race , and clinical diagnosis . RESULTS Overall , an  antibiotic  was prescribed 66 % of the time during office visits for patients with cough : 59 % of patient visits in 1980 rising to 70 % of visits in 1994 ( P = .002 for trend ) . In every study year , white , non-Hispanic patients and patients younger than 65 years were more likely to receive antibiotics  compared with nonwhite patients and patients 65 years or older , respectively . CONCLUSIONS The rate of antibiotic use by primary care physicians for patients with cough remained high from 1980 to 1994 , and was influenced by non clinical characteristics of patients Abstract Background : Acute respiratory infections ( ARI ) are common in children , increasing the pressure on clinicians to prescribe antibiotics and affecting public health Objectives : This study aim ed to design a health education session ( HES ) for caregivers of children , and to evaluate its effects on caregivers ’ needs , as well as on their knowledge and attitudes concerning ARI . Methods : A generalized model of developing , implementing and evaluating a community-based intervention was followed , including caregivers of children under three years of age . Caregivers were r and omly distributed into an intervention group  ( IG ) ( n = 41 ) and a control group ( CG ) ( n = 51 ) and the HES was administered to the IG . The caregivers ’ needs as well as knowledge of and attitudes to ARI were evaluated in both groups , before ( M0 ) and two months after the HES ( M1 ) . Results : At M0 the caregivers from both groups had ‘ some or great need ’ about all HES domains ; at M1 the caregivers in the IG expressed ‘ no or low need ’ , whereas the CG maintained ‘ some or great need ’ about all HES domains ( 0.011 ≤ P ≤ .047 ) . Concerning caregivers ’ knowledge of and attitudes to ARI , at M1 there was a higher frequency of caregivers with right answers in the IG than in the CG ( IG = 7.5 ± 1 versus CG = 6.0 ± 2 ; P = .000 ) . Those differences occurred in domain ( e ) nasal clearance techniques , revealing a higher percentage of caregivers who used correctly nasal irrigation ( P = .000 ) , nasal aspirators ( 0.000 ≤P ≤ .001 ) and nebulization ( P = .000 ) in IG . Conclusion : The HES met the caregivers ’ needs regarding ARI and increased their knowledge and attitudes towards ARI , especially regarding nasal clearance techniques Background Many antibiotics are prescribed inappropriately in pediatric emergency departments ( PEDs ) , but little data are available in these setting s about effective interventions based on guidelines that follow the antimicrobial stewardship principle . Our aim was to assess the impact of implementing the 2011 national guidelines on antibiotic prescriptions for acute respiratory tract infection ( ARTI ) in PEDs . Method We conducted a multicentric , quasiexperimental , interrupted time series analysis of prospect ively collected electronic data from 7 French PEDs . We included all pediatric patients who visited a participating PED during the study period from November 2009 to October 2014 and were diagnosed with an ARTI . The intervention consisted of local protocol implementation , education sessions , and feedback . The main outcome was the antibiotic prescription rate of discharge prescriptions for ARTI per 1000 PED visits before and after implementation , analyzed using the segmented regression model . Results We included 242534 patients with an ARTI . The intervention was associated with a significant change in slope for the antibiotic prescription rate per 1000 PED visits ( -0.4 % per 15-day period , P = .04 ) , and the cumulative effect at the end of the study was estimated to be -30.9 % , ( 95 % CI [ -45.2 to -20.1 ] ) , representing 13136 avoided antibiotic prescriptions . The broad-spectrum antibiotic prescription relative percentage decreased dramatically ( -62.7 % , 95 % CI [ -92.8 ; -32.7 ] ) and was replaced by amoxicillin . Conclusion Implementation of the 2011 national French guidelines led to a significant decrease in the antibiotic prescription rate for ARTI and a dramatic drop in broad-spectrum antibiotic prescriptions , in favor of amoxicillin Background Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare . Objectives To evaluate the efficacy of a multifaceted intervention in reducing early career general practitioners ' ( GPs ' ) antibiotic prescribing for upper respiratory tract infections ( URTIs ) and acute bronchitis/bronchiolitis . Methods A pragmatic non-r and omized trial employing a non-equivalent control group design nested within an existing cohort study of GP registrars ' ( trainees ' ) clinical practice . The intervention included access to online modules ( covering the rationale of current clinical guidelines recommending non-prescription of antibiotics for URTI and bronchitis/bronchiolitis , and communication skills in management of acute bronchitis ) followed by a face-to-face educational session . The intervention was delivered to registrars ( and their supervisors ) in two of Australia 's seventeen regional GP training providers ( RTPs ) . Three other RTPs were the control group . Outcomes were proportion of registrars ' URTI consultations and bronchitis/bronchiolitis consultations prescribed antibiotics . Intention-to-treat analyses employed logistic regression within a Generalised Estimating Equation framework , adjusted for relevant independent variables . The predictors of interest were time ; treatment group ; and an interaction term for time-by-treatment group . The P value associated with an interaction term determined statistically significant differences in antibiotic prescribing . Results Analyses include data of 217 intervention RTPs ' and 311 control RTPs ' registrars . There was no significant reduction in antibiotic prescribing for URTIs . For bronchitis/bronchiolitis , a significant reduction ( interaction P value = 0.024 ) remained true for analysis adjusted for independent variables ( P value = 0.040 ) . The adjusted absolute reduction in prescribing was 15.8 % ( 95 % CI : 4.2%-27.5 % ) . Conclusions A multifaceted intervention reduced antibiotic prescribing for bronchitis/bronchiolitis but not URTIs ABSTRACT We investigated the efficacy of patient-targeted education in reducing  antibiotic prescriptions for upper respiratory tract infections ( URTIs ) among adults in the private primary care setting in Singapore . Our r and omized controlled trial enrolled patients aged 21 years and above presenting at general practitioner ( GP ) clinics with URTI symptoms for 7 days or less . Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs , the role of antibiotics in treating URTIs , and the consequences of inappropriate antibiotic use . Control arm patients were educated on influenza vaccinations . Both arms were compared regarding the proportions prescribed antibiotics and the patients ' postconsultation views . A total of 914 patients consulting 35 doctors from 24 clinics completed the study ( 457 in each arm ) . The demographics of patients in both arms were similar , and 19.1 % were prescribed an antibiotic , but this varied from 0 % to 70 % for individual GPs . The intervention did not significantly reduce antibiotic prescriptions ( odds ratio [ OR ] , 1.20 ; 95 % confidence interval [ CI ] , 0.83–1.73 ) except in patients of Indian ethnicity ( OR , 0.28 ; 95 % CI , 0.09–0.93 ) . Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs ( P = 0.047 ) and on being worried about the side effects of antibiotics ( P = 0.018 ) were restricted to the Indian subgroup . GPs in limited liability partnerships or clinic chains prescribed less ( OR , 0.36 ; 95 % CI , 0.14 to 0.92 ) , while certain inappropriate patient responses were associated with the receipt of antibiotics . Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended Objective To assess the impact on adverse outcomes of different antibiotic prescribing strategies for lower respiratory tract infections in people aged 16 years or more . Design Prospect i ve cohort study . Setting UK general practice . Participants 28 883 patients with lower respiratory tract infection ; symptoms , signs , and antibiotic prescribing strategies were recorded at the index consultation . Main outcome measures The main outcomes were reconsultation with symptoms of lower respiratory tract infection in the 30 days after the index consultation , hospital admission , or death . Multivariable analysis controlled for an extensive list of variables related to the propensity to prescribe antibiotics and for clustering by doctor . Results Of the 28 883 participants , 104 ( 0.4 % ) were referred to hospital for radiographic investigation or admission , or both on the day of the index consultation , or were admitted with cancer . Of the remaining 28 779 , subsequent hospital admission or death occurred in 26/7332 ( 0.3 % ) after no antibiotic prescription , 156/17 628 ( 0.9 % ) after prescription for immediate antibiotics , and 14/3819 ( 0.4 % ) after a prescription for delayed antibiotics . Multivariable analysis documented no reduction in hospital admission and death after immediate antibiotics ( multivariable risk ratio 1.06 , 95 % confidence interval 0.63 to 1.81 , P=0.84 ) and a non-significant reduction with delayed antibiotics ( 0.81 , 0.41 to 1.64 , P=0.61 ) . Reconsultation for new , worsening , or non-resolving symptoms was common ( 1443/7332 ( 19.7 % ) , 4455/17 628 ( 25.3 % ) , and 538/3819 ( 14.1 % ) , respectively ) and was significantly reduced by delayed antibiotics ( multivariable risk ratio 0.64 , 0.57 to 0.72 , P<0.001 ) but not by immediate antibiotics ( 0.98 , 0.90 to 1.07 , P=0.66 ) . Conclusion Prescribing immediate antibiotics may not reduce subsequent hospital admission or death for young people and adults with uncomplicated lower respiratory tract infection , and such events are uncommon . If clinicians are considering antibiotics , a delayed prescription may be preferable since it is associated with a reduced number of reconsultations for worsening illness CONTEXT The impact of clinical decision support systems ( CDSS ) on antimicrobial prescribing in ambulatory setting s has not previously been evaluated . OBJECTIVE To measure the added value of CDSS when coupled with a community intervention to reduce inappropriate prescribing of antimicrobial drugs for acute respiratory tract infections . DESIGN , PARTICIPANTS AND SETTING Cluster r and omized trial that included 407,460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho ( 6 with 1 shared characteristic and 6 with another ) , and a third group of 6 communities that served as non study controls . The preintervention period was January to December 2001 and the postintervention period was January 2002 to September 2003 . Acute respiratory tract infection diagnoses were classified into groups based on indication for antimicrobial use . Multilevel regression methods were applied to account for the clustered design . INTERVENTION Six communities received a community intervention alone and 6 communities received community intervention plus CDSS that were targeted toward primary care clinicians . The CDSS comprised decision support tools on paper and a h and held computer to guide diagnosis and management of acute respiratory tract infection . MAIN OUTCOME MEASURE Community-wide antimicrobial usage was assessed using retail 
    Output:
    
Conclusions The best evidence supports use of specific educational interventions , procalcitonin testing in adults , and electronic decision support to reduce inappropriate antibiotic prescribing for acute RTIs without causing adverse consequences