A digital health algorithm to guide antibiotic prescription in pediatric outpatient care: a cluster randomized...

Area of Science:

• Global Health
• Infectious Diseases
• Digital Health

Background:

• Antimicrobial resistance (AMR) is a critical global health challenge.
• Overuse of antibiotics in primary care contributes to AMR.
• Effective tools are needed to guide antibiotic prescribing for sick children.

Purpose of the Study:

• To evaluate the impact of ePOCT+, a digital clinical decision support tool, on antibiotic prescribing for acutely sick children in Tanzania.
• To compare the clinical effectiveness and safety of ePOCT+ against usual care.

Main Methods:

• A cluster randomized controlled trial was conducted in Tanzanian primary care facilities.
• ePOCT+ integrated C-reactive protein testing, hemoglobin testing, pulse oximetry, and mentorship.
• 23,593 consultations in ePOCT+ facilities and 20,713 in usual care facilities were analyzed over 11 months.

Main Results:

• Antibiotic prescription rates were substantially lower with ePOCT+ (23.2%) compared to usual care (70.1%).
• Clinical failure at day 7 was noninferior between the ePOCT+ and usual care groups (aRR 0.97, 95% CI 0.85 to 1.10).
• No significant differences were observed in secondary safety outcomes like death or hospitalizations.

Conclusions:

• The ePOCT+ digital tool effectively reduces unnecessary antibiotic prescribing in primary care settings.
• ePOCT+ offers a safe and viable strategy to combat antimicrobial resistance in pediatric care.
• Digital health interventions show promise for improving antibiotic stewardship globally.