To the Editor: Dr Samore and colleagues1 described the results of an effort to improve appropriateness of antibiotic use with a clinical decision support system (CDSS). We have some concerns whether the difference in effect between the CDSS group and the community intervention group can be ascribed to the decision support that was offered.
Table 2 indicates that several components of the community intervention differed between the 2 groups, favoring the CDSS group. Although the groups were roughly similar in population size, 83% more posters and 42% more brochures were distributed in the communities in the CDSS group. Household mailings and self-care guides distributed at health fairs also favored the CDSS group by 23% and 26%, respectively. The difference in intensity of the community intervention is an alternate explanation for the difference in effect between the 2 groups.
A 10% reduction of prescribing rates seems to be the best achievable effect in more actively delivered complex interventions to reduce antimicrobial prescribing, compared with smaller effects in more passively delivered interventions.2 A change to prescribing of more first-choice antibiotics seems to be easier than reducing the number of antimicrobial prescriptions.3 - 4 We agree that more potent interventions are needed to adequately control antimicrobial resistance. However, the consolidation of these effects also needs to be monitored to assess sustainability over the long run.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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