Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of
Marieke B Lemiengre1, Jan Y Verbakel2, Roos Colman1
1Department of Public Health, Ghent University, Ghent, Belgium.
Insights
Point-of-care C-reactive protein testing did not reduce antibiotic prescribing for children with non-severe infections. However, a brief intervention to address parental concern increased prescribing, suggesting a need for better physician training.
Area of Science:
- Pediatric primary care
- Infectious disease management
- Clinical trial methodology
Background:
- Antibiotic overuse for non-severe childhood infections is a significant issue in primary care.
- This contributes to antimicrobial resistance and adverse effects.
- Effective strategies are needed to curb inappropriate prescribing.
Purpose of the Study:
- To evaluate the effectiveness of two interventions in reducing antibiotic prescribing for children with non-severe acute infections.
- Interventions included point-of-care C-reactive protein (POC CRP) testing and a brief intervention addressing parental concern with safety net advice (BISNA).
Main Methods:
- A cluster randomized factorial controlled trial was conducted in primary care in Flanders, Belgium.
- Family physicians (FPs) enrolled children with non-severe acute infections.
- Participants were assigned to usual care, POC CRP, BISNA, or a combination of both.
Main Results:
- POC CRP testing alone did not significantly alter immediate antibiotic prescribing rates compared to usual care.
- The BISNA intervention was associated with an increase in antibiotic prescribing.
- Combining POC CRP with BISNA negated the increase in antibiotic prescribing observed with BISNA alone.
Conclusions:
- Systematic POC CRP testing without interpretation guidance is ineffective in reducing antibiotic prescribing for children with non-severe acute infections.
- Addressing parental concern without POC CRP testing inadvertently increased antibiotic prescribing.
- Further training for FPs on managing parental concerns without inappropriate antibiotic prescription is recommended.
Background:
Antibiotics are overprescribed for non-severe acute infections in children in primary care.
Aim:
To explore two different interventions that may reduce inappropriate antibiotic prescribing for non-severe acute infections.
Design And Setting:
A cluster randomised, factorial controlled trial in primary care, in Flanders, Belgium.
Method:
Family physicians (FPs) enrolled children with non-severe acute infections into this study. The participants were allocated to one of four intervention groups according to whether the FPs performed: (1) a point-of-care C-reactive protein test (POC CRP); (2) a brief intervention to elicit parental concern combined with safety net advice (BISNA); (3) both POC CRP and BISNA; or (4) usual care (UC). Guidance on the interpretation of CRP was not provided. The main outcome was the immediate antibiotic prescribing rate. A mixed logistic regression was performed to analyse the data.
Results:
In this study 2227 non-severe acute infections in children were registered by 131 FPs. In comparison with UC, POC CRP did not influence antibiotic prescribing, (adjusted odds ratio [AOR] 1.01, 95% confidence interval [CI] = 0.57 to 1.79). BISNA increased antibiotic prescribing (AOR 2.04, 95% CI = 1.19 to 3.50). In combination with POC CRP, this increase disappeared.
Conclusion:
Systematic POC CRP testing without guidance is not an effective strategy to reduce antibiotic prescribing for non-severe acute infections in children in primary care. Eliciting parental concern and providing a safety net without POC CRP testing conversely increased antibiotic prescribing. FPs possibly need more training in handling parental concern without inappropriately prescribing antibiotics.
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