In 1995 the Centers for Disease Control and Prevention (CDC) developed a campaign to reduce inappropriate antibiotic use and rising rates of antimicrobial resistance. In 2003 the campaign was branded and launched as Get Smart: Know When Antibiotics Work. The Get Smart campaign has three objectives: to promote providers' adherence to appropriate prescribing guidelines, to decrease the demand for antibiotics for viral upper respiratory infections from healthy adults and parents of young children, and to increase adherence to antibiotic regimens prescribed for upper respiratory infections. The campaign is aimed at both the general public and health care providers because the knowledge, attitudes, and behaviors of both groups contribute to the use of antibiotics. A primary focus of the Get Smart campaign is the development and dissemination of educational materials such as fact sheets, brochures, and posters for the general public, as well as adult and pediatric "academic detailing sheets" for providers. The latter give disease-specific diagnostic and treatment guidelines for various acute respiratory infections (go to http://www.cdc.gov/getsmart).

Educational materials for the general public. The Get Smart campaign has also developed brochures, posters, and information sheets for a variety of audiences, including Spanish-speaking, American Indian, and Alaska Native populations. Two question-and-answer pages specifically designed for parents address runny noses and fluid in the middle ear. All of the materials are available at the campaign's Web site and may be downloaded, copied, and distributed without alteration free of charge. Large quantities are available for purchase from the Public Health Foundation (go to http://bookstore.phf.org/index.php?cPath=69_55 or call [877] 252-1200 between 9 AM and 4:30 PM EST).

In addition to developing and distributing written materials, the Get Smart campaign, in partnership with the Food and Drug Administration, developed a national media campaign to provide a coordinated public message on appropriate antibiotic use. The media campaign was launched in 2003 and is currently being disseminated through print, television, radio, and outdoor media.

Materials for health care providers include guidelines for the management of acute respiratory infection in both adults and children as well as quick summary sheets of those guidelines. The campaign also offers several tools to help clinicians educate patients on appropriate antibiotic use. For example, a viral "prescription pad" is available that reinforces the patient's diagnosis of a viral illness and not a bacterial infection. The pad provides recommendations for symptomatic relief that the clinician can check off and explains when the patient should return if the symptoms do not subside.

The Get Smart campaign has also supported the development of a curriculum for medical students on the appropriate use of antibiotics (a collaboration with the University of California, San Diego, and the Association of American Medical Colleges). And there are two curricula for medical residents. One is modeled after the medical school curriculum and is under development at the Oregon Health and Science University. The other curriculum is designed to increase residents' proficiency in the diagnosis of acute otitis media using video otoscopy, among other techniques, and is available from the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center at http://www.eprom.pitt.edu/34_viewPage.asp?pageID=1579464186. Plans are also under way to develop continuing education courses for nurses, NPs, physician assistants, and pharmacists.

HEDIS performance measures. The CDC and the National Committee for Quality Assurance (a not-for-profit organization involved in health care improvement) have written four measures for the Healthcare Effectiveness Data and Information Set (HEDIS), the performance measurement tool used by more than 90% of the nation's health plans. The pediatric measures, which became part of HEDIS in 2004, assess the testing of children with pharyngitis and the treatment of children with upper respiratory infections for their appropriateness. The adult measures, which became part of HEDIS in 2006 and 2008, assess providers' avoidance of antibiotic treatment in adults with acute bronchitis and data on antibiotic prescribing practices.