A systematic review of national interventions and policies to optimize antibiotic use in healthcare settings in England

The study aimed to assess the effectiveness of national antibiotic optimization interventions in primary and secondary care in England from 2013-2022. A systematic scoping review identified 109 interventions in eight categories, including policy and commissioning, classifications, guidance and toolkits, monitoring and feedback, professional engagement and training, prescriber tools, public awareness, and workforce and governance. Most interventions lack high-quality effectiveness evidence, with the largest reduction reported with structural-level interventions. The combination of interventions may explain England’s decline in prescribing, but direct evidence of causality is unavailable.