A new study has found that using a digital support algorithm to guide diagnosis and treatment by healthcare providers significantly reduced the number of antibiotic prescriptions given to acutely sick children, without affecting treatment success or causing harm.
The rising worldwide problem of bacterial antimicrobial resistance (AMR) is well-known, leading to a population of pathogens resistant to antibiotic treatment. One of the primary contributors is the inappropriate and excessive prescription of antibiotics.
Electronic clinical decision support algorithms (CDSA) are digital health or mobile health tools that guide healthcare providers on what symptoms and signs to assess, advise on what tests to perform, and propose the appropriate diagnoses, treatments, and management. Researchers from the University of Lausanne (UNIL), Switzerland, have developed a CDSA to guide antibiotic prescription in pediatric patients.
Called ePOCT+, the CDSA is a digital clinical decision support algorithm to guide healthcare providers in managing acutely sick children under 15. It uses the results of basic tests – C-reactive protein (CRP), hemoglobin, and pulse oximetry – to provide advice on potential treatments.
To examine the effect of ePOCT+ on antibiotic prescription compared to usual care, the researchers conducted a randomized controlled trial in Tanzanian primary care facilities. In Tanzania and many other resource-limited countries, more than 50% of sick children receive antibiotics when visiting a health facility, with 80% to 90% prescribed at the outpatient level; most are deemed inappropriate.
Over 11 months, 23,593 consultations were included from 20 ePOCT+ health facilities and 20,173 from 20 regular care health facilities. Study participants were between 2 months and 14 years old. The researchers found that overall antibiotic prescription at initial consultations was 23.2% when ePOCT+ was used and 70.1% in routine care health facilities not using the algorithm.
This equates to close to a three-fold reduction in the likelihood of a sick child receiving an antibiotic prescription when the algorithm was employed compared to when it was not. The reduction in antibiotic prescriptions in ePOCT+ facilities did not cause an increase in adverse events for the patients, as no difference in the treatment failure rate was observed.
The researchers note that nearly 25% of patients were not managed using ePOCT+ despite being in the intervention group, which they attribute to lower uptake of the tool due to the need for entering clinical data several times, including in the electronic medical record (EMR), ePOCT+, and a paper log, which would have prolonged consultation time. Issues that prevented the use of ePOCT+ and similar tools by healthcare providers are being evaluated by the researchers so that these tools can be adequately scaled up in Tanzania and other countries.
“Widespread implementation of ePOCT+ could help address the urgent problem of antimicrobial resistance by reducing excessive antibiotic prescription in sick children while maintaining clinical safety,” said the researchers.
The study was published in the journal Nature Medicine.