Review Article| Volume 41, ISSUE 3, P552-581, March 2019

Computerized Clinical Decision Support Systems and Antibiotic Prescribing: A Systematic Review and Meta-analysis

  • Eduardo Carracedo-Martinez
    Address correspondence to: Eduardo Carracedo Martinez, Aparta de Correos 466, 15786, Santiago de Compostela, A Coruña, Spain.
    Santiago de Compostela Health Area, Galician Health Service (Servizo Galego de Saúde-SERGAS), Spanish National Health System, Santiago de Compostela, Spain
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  • Christian Gonzalez-Gonzalez
    Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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  • Antonio Teixeira-Rodrigues
    Department of Medical Sciences and Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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  • Jesus Prego-Dominguez
    Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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  • Bahi Takkouche
    Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain

    Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
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  • Maria Teresa Herdeiro
    Department of Medical Sciences and Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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  • Adolfo Figueiras
    Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain

    Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain

    Institute of Health Research of Santiago de Compsotela (IDIS), Spain
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  • on behalf ofthe Galician Pharmacoepidemiology Research Group
    Author Footnotes
    † Members of the Galician Pharmacoepidemiology Research Study Group are listed in the Acknowledgments.
  • Author Footnotes
    † Members of the Galician Pharmacoepidemiology Research Study Group are listed in the Acknowledgments.



      The aim of this study was to perform a systematic review and meta-analysis of studies performed in primary care centers and hospital facilities that evaluated the effectiveness of computerized clinical decision support systems (CDSSs) in decision making on the prescription of any given antibiotic.


      We conducted a search of the MEDLINE and EMBASE databases. A meta-analysis was then conducted of all variables with results reported in >2 studies.


      A total of 42 of the 46 studies included in the review identified a statistically significant advantage for CDSSs in ≥1 study variables. The effect of CDSSs on the percentage accuracy of the antibiotic spectrum prescribed empirically with respect to the microbial agent's susceptibility, which is one of the most frequently studied outcome variables, was examined in 7 studies, all undertaken in hospital settings. In all these studies but one, CDSSs resulted in a statistically significant increase in percentage accuracy. The other study variables present in >2 studies had more inconsistent results. Although the results of the meta-analysis of the variables percentage accuracy, antibiotic prescription rate in hospital, percentage adherence to antibiotic prescription guidelines in primary care or hospital, and percentage of inappropriate prescriptions for antibiotics in primary care were statistically significantly favorable to CDSSs; in the case of hospital length of stay and mortality, they were favorable although not statistically significantly.


      CDSSs appear to be useful for variables such as the percentage of appropriate empirical treatment in the hospital setting or to induce changes in antibiotics prescription rate. Even so, more better quality studies are required to draw clearer conclusions in respect of morbidity and mortality outcome variables and other settings.


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