Reducing inappropriate antibiotic prescribing for acute respiratory tract infections using an antibiotic training and management program led by local hospitals in China

INTERVENTION: All recruited township hospitals will be stratified by county and be randomized into the intervention or control group in an overall 1:1 ratio with a 8:9 ratio within each county. The control group will continue usual care according to the current national guidelines. Treatment will be provided according to existing knowledge and antibiotics will be given at the individual clinician’s discretion. The intervention will last for 12 months followed by a 24‐month follow‐up during the post‐intervention period. The intervention group will receive an intervention package target on both health care providers and patients including the following: For healthcare provider: 1. An improved antibiotic stewardship (AMS) in each township hospital that includes an AMS team established to determine AMS policies in the institute and an AMS working group to hold monthly peer review meetings on prescriptions for acute RTIs with a standard procedure using EMR and WeChat app 2. Operational concise guidelines for RTIs based on Chinese antibiotics use guidelines, IMCI, British Thoracic Society/ NICE guidelines, and American Association of Pediatrics guidelines covering the contents of patient symptom based diagnostic algorithms, appropriate use of antibiotics, key health education messages and referral suggestions provided for township hospital and village doctors in both printed and WeChat app version 3. Training on operational guideline and communication skills for township hospital and village doctors, reading chest X‐ray reports from radiologists and an innovatively developed program embedded in the WeChat app to monitor and review antibiotics prescribing in each township hospital 4. Improved electronic prescription system including an embedded clinical decision module to prescribe antibiotics carefully, an alarm system to suggest necessary tests, and pop‐ups to recommend CONDITION: Acute respiratory tract infections, including acute upper respiratory tract infections and acute bronchitis ; Infections and Infestations PRIMARY OUTCOME: ; Proportion of prescriptions for acute RTIs that contain any antibiotic.; All primary and secondary outcomes will be collected from electronic medical records at baseline (12 months before intervention), intervention period (12 months) and long‐term follow‐up period (24 months after intervention).; SECONDARY OUTCOME: ; 1. Broad spectrum antibiotic prescription rate; 2. Prescription rate for broad spectrum antibiotics excluding amoxicillin‐clavulanic acid; 3. Prescription rate for multiple antibiotics; 4. Intravenous injection antibiotic prescription rate; 5. Prescription rate for alternative medicines; 6. Average cost of a prescription; All primary and secondary outcomes will be collected from electronic medical records at baseline (12 months before intervention), intervention period (12 months) and long‐term follow‐up period (24 months after intervention).; INCLUSION CRITERIA: Healthcare professionals: 1. Physicians, pharmacists, radiologists and directors in enrolled township hospitals in two selected counties in Shaoguan City, Guangdong Province who agree to participate in the study Patient/caregivers: 1. Patients aged 0‐75 years diagnosed with acute RTIs and/or their caregivers