A digital health algorithm to guide antibiotic prescription in pediatric outpatient care: a cluster randomized controlled trial - Tan, R.; Kavishe, G.; Luwanda, L. B.; Kulinkina, A. V.; Renggli, S.; Mangu, C.; Ashery, G.; Jorram, M.; Mtebene, I. E.; Agrea, P.; Mhagama, H.; Vonlanthen, A.; et al. (Nat Med, 2023)
Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital clinical decision support algorithm in combination with C-reactive protein test, hemoglobin test, pulse oximeter and mentorship, to guide health-care providers in managing acutely sick children under 15 years old. To evaluate the impact of ePOCT+ compared to usual care, we conducted a cluster randomized controlled trial in Tanzanian primary care facilities. Over 11 months, 23,593 consultations were included from 20 ePOCT+ health facilities and 20,713 from 20 usual care facilities. The use of ePOCT+ in intervention facilities resulted in a reduction in the coprimary outcome of antibiotic prescription compared to usual care (23.2% versus 70.1%, adjusted difference -46.4%, 95% confidence interval (CI) -57.6 to -35.2). The coprimary outcome of day 7 clinical failure was noninferior in ePOCT+ facilities compared to usual care facilities (adjusted relative risk 0.97, 95% CI 0.85 to 1.10). There was no difference in the secondary safety outcomes of death and nonreferred secondary hospitalizations by day 7. Using ePOCT+ could help address the urgent problem of antimicrobial resistance by safely reducing antibiotic prescribing. Clinicaltrials.gov Identifier: NCT05144763.
Keywords: journalArticle; *Anti-Bacterial Agents/therapeutic use; *Digital Health; Adolescent; Algorithms; Ambulatory Care; Child; Humans; Prescriptions; Primary Health Care