***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 
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    ***EXAMPLES*** 
    Input: Summary Background Unnecessary antibiotic prescribing contributes to antimicrobial resistance . In this trial , we aim ed to reduce unnecessary prescriptions of antibiotics by general practitioners ( GPs ) in Engl and . Methods In this r and omised , 2 × 2 factorial trial , publicly available data bases were used to identify GP practice s whose prescribing rate for antibiotics was in the top 20 % for their National Health Service ( NHS ) Local Area Team . Eligible practice s were r and omly assigned ( 1:1 ) into two groups by computer-generated allocation sequence , stratified by NHS Local Area Team . Participants , but not investigators , were blinded to group assignment . On Sept 29 , 2014 , every GP in the  feedback intervention group was sent a letter from Engl and 's Chief Medical Officer and a leaflet on antibiotics for use with patients . The letter stated that the practice was prescribing antibiotics at a higher rate than 80 % of practice s in its NHS Local Area Team . GPs in the control group received no communication . The sample was re-r and omised into two groups , and in December , 2014 , GP practice s were either sent patient-focused information that promoted reduced use of antibiotics or received no communication . The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population , controlling for past prescribing . Analysis was by intention to treat . This trial is registered with the IS RCT N registry , number IS RCT N32349954 , and has been completed . Findings Between Sept 8 and Sept 26 , 2014 , we recruited and assigned 1581 GP practice s to feedback intervention ( n=791 ) or control ( n=790 ) groups . Letters were sent to 3227 GPs in the intervention group . Between October , 2014 , and March , 2015 , the rate of antibiotic items dispensed per 1000 population was 126·98 ( 95 % CI 125·68–128·27 ) in the feedback intervention group and 131·25 ( 130·33–132·16 ) in the control group , a difference of 4·27 ( 3·3 % ; incidence rate ratio [ IRR ] 0·967 [ 95 % CI 0·957–0·977 ] ; p<0·0001 ) , representing an estimated 73 406 fewer antibiotic items dispensed . In December , 2014 , GP practice s were re-assigned to patient-focused intervention ( n=777 ) or control ( n=804 ) groups . The patient-focused intervention did not significantly affect the primary outcome measure between December , 2014 , and March , 2015 ( antibiotic items dispensed per 1000 population : 135·00 [ 95 % CI 133·77–136·22 ] in the patient-focused intervention group and 133·98 [ 133·06–134·90 ] in the control group ; IRR for difference between groups 1·01 , 95 % CI 1·00–1·02 ; p=0·105 ) . Interpretation Social norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale ; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes . Funding Public Health Engl and From 1998 to 2000 , 13 rural Alaskan villages ( population , 3326 ) were surveyed annually by nasopharyngeal cultures for Streptococcus pneumoniae carriage . Data regarding antibiotic use for the entire population was abstract ed from clinic records . In 1999 , education of medical providers and the community about appropriate antibiotic use began in 4 villages ; this program was exp and ed to include all villages in 2000 .  Antibiotic courses per person decreased by 31 % in the initial intervention villages and by 35 % in the remaining villages after education ( P<.01 for each ) . Sample s were obtained for culture from a mean of 31 % of the population each year ; 31 % carried pneumococcus . No sustained decrease in carriage of penicillin-nonsusceptible strains was observed . When linear regression was used , serotype accounted for 81 % of the variance in pneumococcal minimum inhibitory concentrations after the intervention , compared with 7 % for antibiotic use . This suggests that reducing the carriage of serotypes associated with antibiotic resistance by use of pneumococcal conjugate vaccines may have a greater short-term impact than does decreasing antibiotic use 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 China ’s Ministry of Health ( MOH ) has established a policy about the antimicrobial stewardship . To date , the effects of this policy on multidrug-resistant organism ( MDRO ) in critically ill patients are unknown . Methods A pre-post study was conducted on intensive care unit ( ICU ) patients from June 2010 to May 2011 and from June 2012 to May 2013 . Bacterial cultures were conducted at ICU admission and discharge . In June 2011 , our hospital started to administer the antimicrobial stewardship program of Chinese MOH . We collected the data on antimicrobial consumption during the 3-year period in all hospital and individual department every month , and analyzed the correlation between the proportion of critically patients colonized or infected with MDRO and antimicrobial consumption . Results A total of 978 patients were involved in the present study . With the intervention , the monthly mean Defined Daily Dose ( DDD ) per 100 occupied bed-days throughout the hospital decreased from 96 ± 7 to 65 ± 6 ( p < 0.001 ) , and the proportion of patients colonized or infected with MDRO decreased from 36 to 13 % at the time of ICU admission and declined from 48 to 29 % at the time of ICU discharge ( both p < 0.001 ) . There was a significant positive relationship between the proportion of all critically ill patients colonized or infected with MDRO at ICU admission and the DDD of the entire hospital ( R2 = 0.7858 , p < 0.001 ) . Conclusion The antimicrobial stewardship program of Chinese MOH reduced the consumption of antibiotics . Moreover , the proportion of patients colonized or infected with MDRO decreased along with reduced consumption of antibiotics . Trial registration Retrospectively registered : NCT02128399 ; Date of registration : 22 APR 2014 ; Detail information web link : https:// clinical Background Presumptive treatment of all febrile patients with anti-malarials leads to massive over-treatment . The aim was to assess the effect of implementing malaria rapid diagnostic tests ( m RDTs ) on prescription of anti-malarials in urban Tanzania . Methods The design was a prospect i ve collection of routine statistics from ledger books and cross-sectional surveys before and after intervention in r and omly selected health facilities ( HF ) in Dar es Salaam , Tanzania . The participants were all clinicians and their patients in the above health facilities . The intervention consisted of training and introduction of m RDTs in all three hospitals and in six HF . Three HF without m RDTs were selected as matched controls . The use of routine m RDT and treatment upon result was advised for all patients complaining of fever , including children under five years of age . The main outcome measures were : ( 1 ) anti-malarial consumption recorded from routine statistics in ledger books of all HF before and after intervention ; ( 2 ) anti-malarial prescription recorded during observed consultations in cross-sectional surveys conducted in all HF before and 18 months after m RDT implementation . Results Based on routine statistics , the amount of artemether-lumefantrine blisters used post-intervention was reduced by 68 % ( 95%CI 57 - 80 ) in intervention and 32 % ( 9 - 54 ) in control HF . For quinine vials , the reduction was 63 % ( 54 - 72 ) in intervention and an increase of 2.49 times ( 1.62 - 3.35 ) in control HF . Before- and -after cross-sectional surveys showed a similar decrease from 75 % to 20 % in the proportion of patients receiving anti-malarial treatment ( Risk ratio 0.23 , 95%CI 0.20 - 0.26 ) . The cluster r and omized analysis showed a considerable difference of anti-malarial prescription between intervention HF ( 22 % ) and control HF ( 60 % ) ( Risk ratio 0.30 , 95%CI 0.14 - 0.70 ) . Adherence to test result was excellent since only 7 % of negative patients received an anti-malarial . However , antibiotic prescription increased from 49 % before to 72 % after intervention ( Risk ratio 1.47 , 95%CI 1.37 - 1.59 ) . Conclusions Programmatic implementation of m RDTs in a moderately endemic area reduced drastically over-treatment with anti-malarials . Properly trained clinicians with adequate support complied with the recommendation of not treating patients with negative results . Implementation of m RDT should be integrated h and -in-h and with training on the management of other causes of fever to prevent irrational use of antibiotics AIM To assess the impact of the National Essential Medicines Policy ( NEMP ) on the use of medicines in government-owned primary care institutions in Hubei province of China . STUDY DESIGN Quasi-experimental design and time-trend analysis . METHODS A systematic r and om sampling strategy was employed to select 55,800 prescriptions from 18 primary care organizations who progressively implemented the NEMP from January 2009 to July 2011 . We examined the change of patterns of prescriptions . The facilities that implemented the NEMP at a later stage served as control . RESULTS An immediate increased uptake of essential medicines of all drugs prescribed which ultimately neared 95 % . In total , 38,151 prescriptions ( 68 % ) involved antibiotics , and we found no evidence of reduction after the NEMP interventions . A high percentage ( 59 - 66 % ) of prescription drugs were administered through parenteral routes and no reduction was found after the NEMP interventions . Although the average number of medicines per prescription remained unchanged ( nearly four ) , the average cost per prescription declined significantly after the NEMP interventions ( ¥ 44.67 vs ¥ 26.67 CNY , P < 0.03 ) . CONCLUSIONS The NEMP interventions reduced the average cost per prescription ; however , the irrational use of antibiotics and unnecessary parenteral administration remains prevalent . The goals of the NEMP are partially achieved ; we therefore recommend a strategic approach involving all stakeholders to comprehensively achieve all aspirations Objectives To test the hypothesis that a multifaceted , local public campaign could be feasible and influence antibiotic prescribing for out patients . Design Community level , controlled , non-r and omised trial . Setting Provinces of Modena and Parma in Emilia-Romagna , northern Italy , November 2011 to February 2012 . Population 1 150 000 residents of Modena and Parma ( intervention group ) and 3 250 000 residents in provinces in the same region but where no campaign had been implemented ( control group ) . Interventions Campaign material s ( mainly posters , brochures , and advertisements on local media , plus a newsletter on local antibiotic resistance targeted at doctors and pharmacists ) . General practitioners and paediatricians in the intervention area participated in design ing the campaign messages . Main outcomes measures Primary outcome was the average change in prescribing rates of antibiotics for outpatient in five months , measured as defined daily doses per 1000 inhabitants/ 
    Output:
    
To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR .