Effect of changes in antibiotic prescribing on patient outcomes in a community setting: A natural experiment in Australia

This study examined whether a significant change in antibiotic use caused b y an Australian government directive targeted at amoxicillin with clavulani c acid (AC) was associated with changes in prescription share, health care costs, and patient outcomes. We used an integrated database of computerized general practice medical records, which included data regarding 34,242 pat ients and 318,234 recorded patient visits. There were 15,303 antibiotic pre scriptions provided to 9921 patients during a 4-year period, with AC prescr ibed for 1453 (14.6%) of these patients. A total of 5125 patient outcomes w ere identified. There was a shift away from best-practice antibiotic prescr ibing, and a significant association was identified between the rate and co st of process-of-care and patient outcomes and the decrease in AC-prescript ion share. This policy initiative created unintended changes in prescribing behavior, increased costs to the government, and a trend toward poorer pat ient outcomes. Detailed analyses are required before instigating initiative s aimed at changing clinicians' prescribing behavior.