Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions.
Marieke B Lemiengre, Jan Y Verbakel, Roos Colman, Tine De Burghgraeve, Frank Buntinx, Bert Aertgeerts, Frans De Baets, An De Sutter
Author Information
Marieke B Lemiengre: Department of Public Health, Ghent University, Ghent, Belgium.
Jan Y Verbakel: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, and assistant professor, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Roos Colman: Department of Public Health, Ghent University, Ghent, Belgium.
Tine De Burghgraeve: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Frank Buntinx: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium, and Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands.
Bert Aertgeerts: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Frans De Baets: Department of Pediatric Pulmonology, Infection and Immune Deficiencies, Ghent University Hospital, Ghent, Belgium.
An De Sutter: Department of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.
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.
