{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:15:32Z","timestamp":1790320532084,"version":"4.1.0"},"reference-count":55,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T00:00:00Z","timestamp":1596758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Unnecessary antibiotic prescribing contributes to Antimicrobial Resistance posing a major public health risk. Estimates suggest as many as half of antibiotics prescribed for respiratory infections may be unnecessary. We conducted a three-armed unblinded cluster randomized controlled trial (ISRCTN trial registry 83322985). Interventions were a commitment poster (CP) advocating safe antibiotic prescribing or a CP plus an antimicrobial stewardship message (AM) on telephone appointment booking lines, tested against a usual care control group. The primary outcome measure was antibiotic item dispensing rates per 1000 population adjusted for practice demographics. The outcome measures for post-hoc analysis were dispensing rates of antibiotics usually prescribed for upper respiratory tract infections and broad spectrum antibiotics. In total, 196 practice units were randomized to usual care (n = 60), CP (n = 66), and CP&amp;AM (n = 70). There was no effect on the overall dispensing rates for either interventions compared to usual care (CP 5.673, 95%CI \u22129.768 to 21.113, p = 0.458; CP&amp;AM, \u221212.575, 95%CI \u221230.726 to 5.576, p = 0.167). Secondary analysis, which included pooling the data into one model, showed a significant effect of the AM (\u221218.444, 95%CI \u221232.596 to \u22124.292, p = 0.012). Fewer penicillins and macrolides were prescribed in the CP&amp;AM intervention compared to usual care (\u221212.996, 95% CI \u221234.585 to \u22124.913, p = 0.018). Commitment posters did not reduce antibiotic prescribing. An automated patient antimicrobial stewardship message showed effects and requires further testing.<\/jats:p>","DOI":"10.3390\/antibiotics9080490","type":"journal-article","created":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T09:30:54Z","timestamp":1596792654000},"page":"490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial"],"prefix":"10.3390","volume":"9","author":[{"given":"Anna","family":"Sallis","sequence":"first","affiliation":[{"name":"Public Health England Behavioural Insights (PHEBI), Research, Translation &amp; Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Bondaronek","sequence":"additional","affiliation":[{"name":"Public Health England Behavioural Insights (PHEBI), Research, Translation &amp; Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK"},{"name":"eHealth Unit, Research Department of Primary Care and Population Health, University College London, London SE1 8UG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jet G.","family":"Sanders","sequence":"additional","affiliation":[{"name":"Public Health England Behavioural Insights (PHEBI), Research, Translation &amp; Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK"},{"name":"Department of Psychological and Behavioural Science, London School of Economics and Political Sciences, London SE1 8UG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ly-Mee","family":"Yu","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Harris","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Vlaev","sequence":"additional","affiliation":[{"name":"Warwick Business School, University of Warwick, Coventry CV4 7AL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sanders","sequence":"additional","affiliation":[{"name":"The Behavioural Insights Team. 4 Matthew Parker St, Westminster, London SW1H 9NP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4470-1151","authenticated-orcid":false,"given":"Sarah","family":"Tonkin-Crine","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK"},{"name":"NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX2 6GG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Chadborn","sequence":"additional","affiliation":[{"name":"Public Health England Behavioural Insights (PHEBI), Research, Translation &amp; Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,7]]},"reference":[{"key":"ref_1","unstructured":"World Health Organisation (2020, May 13). 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