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Randomized Controlled Trial
. 2018 Mar;68(668):e204-e210.
doi: 10.3399/bjgp18X695033. Epub 2018 Feb 12.

Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions

Marieke B Lemiengre  1 , Jan Y Verbakel  2 , Roos Colman  1 , Tine De Burghgraeve  3 , Frank Buntinx  4 , Bert Aertgeerts  3 , Frans De Baets  5 , An De Sutter  6
Affiliations
Randomized Controlled Trial

Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions

Marieke B Lemiengre et al. Br J Gen Pract. 2018 Mar.

Abstract

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.

Keywords: children; cluster randomised controlled trial; inappropriate prescribing; physician–patient communication; point-of-care testing; primary care.

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Figures

Figure 1.
Figure 1.
Flow chart representing the number of acute infectious episodes included in the study. a Scoring positive at one of the following clinical criteria: gut feeling of the physician, presence of dyspnoea, temperature ≥40°C, and diarrhoea in children aged between 1 and 2.5 years. BISNA = brief intervention with safety net. CDR = clinical decision rule. CRP = C-reactive protein. FP = family physician. R = randomisation. UC = usual care.
Figure 2.
Figure 2.
Estimated marginal means of the immediate antibiotic prescribing rate (with 95% confidence interval) for the different intervention groups (adjusted analysis). BISNA = brief intervention with safety net. CRP = C-reactive protein. UC = usual care.
See this image and copyright information in PMC

Comment in

References

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