Trial of a multi-faceted intervention to improve management of antibiotics for children presenting with respiratory tract infections

1. Amongst children aged 0-9 years presenting to a general practice clinic with respiratory infections, an intervention encompassing risk stratification and caregiver education did not decrease antibiotic dispensing rates, or increase hospital admission rates.

Evidence Rating Level: 1 (Excellent)

Widespread and unnecessary prescribing of antibiotics carries the potential for development of antibiotic resistance. However, an estimated 50% of antibiotics prescribed in primary care are unnecessary, particularly for respiratory infections in children. Prior studies have identified contributing factors, including physicians prescribing antibiotics “just in case” or parents needing more information on managing and monitoring respiratory infections at home. As such, this current study, known as the Children’s Cough (CHICO) trial, randomized primary care practices in England to evaluate an intervention aimed at reducing antibiotic prescriptions without increasing hospital admissions, in children aged 0-9 years with respiratory infection symptoms. This intervention employed the short illness, temperature, age, recession, wheeze, asthma, and vomiting (STARWAVe) prognostic algorithm to determine a child’s risk of hospital admission in 30 days, into very low, normal, and high risk categories. Since the intervention was embedded into the physician’s electronic medical record, the physician would be prompted to elicit concerns from the child’s caregivers during the appointment. They would also be able to provide a handout outlining strategies to manage and monitor their child’s symptoms for deterioration, which would also be personalized to the caregivers’ concerns. In total, there were 150 general practices enrolled in the control group and 144 enrolled in the intervention group. Amongst the intervention, 17% of practices had zero usage over the 12-month study period. The results showed no differences in antibiotic dispensing between intervention and control groups (rate ratio 1.011, 95% CI 0.992-1.029, p = 0.25). As well, the hospital admission rate for respiratory infections was non-inferior in the intervention compared to the control (rate ratio 0.952, 95% CI 0.905-1.003). Overall, this study demonstrated that an intervention incorporating risk stratification and caregiver education did not reduce antibiotic dispensing or increase hospital admission rates, for children with respiratory infections presenting to a general practice clinic.

Click to read the study in BMJ

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