Impact of a multifaceted intervention including supportive care order sentence implementation on outpatient antibiotic prescribing for upper respiratory tract infections.

Objective: Compare the incidence of antibiotic prescribing for bronchitis and sinusitis before and after implementation of a multifaceted outpatient stewardship intervention.

Design: Retrospective, quasi-experimental study.

Setting: Three primary care clinics within a Michigan health system.

Patients: Age 3 months and older who were diagnosed with acute bronchitis or rhinosinusitis.

Intervention: Provider education paired with electronic health record order sentences for supportive care were implemented in September 2024. Patients diagnosed with bronchitis or sinusitis between October 2023 and January 2024 were included in the pre-intervention group (pre-ASP) while patients diagnosed between October 2024 and January 2025 were in the post-implementation group (post-ASP).

Results: Total antibiotic prescribing for acute bronchitis and rhinosinusitis decreased significantly following the intervention (pre-ASP 65.6% vs post-ASP 53.9%, P = .024) and was driven by a significant reduction in prescribing for bronchitis post-ASP (36.7% vs 21.1%, P = .021). Antibiotic prescribing for rhinosinusitis decreased but did not reach statistical significance (94.4% vs 86.7%, P = .074). The relative reduction in antibiotic prescribing in the presence of a supportive care prescription for acute bronchitis was 51.2% (37.1% vs 18.1%, P = .018).

Conclusions: Supportive care order sentence implementation paired with provider education may be an effective outpatient stewardship practice to reduce antibiotic prescribing for URI.