Belgian study: New approach to reduce antibiotic prescriptions for children by a quarter
A new approach for general practitioners could reduce the number of antibiotic prescriptions for sick children by a quarter, without any negative consequences. That shows a study by six Belgian universities, led by KU Leuven.
Antibiotic (or antimicrobial) resistance is one of the greatest threats to public health worldwide. Unnecessary antibiotic prescriptions, for example for respiratory or ear infections, are a major cause. In Belgium, one in five children who visit their GP when ill are prescribed antibiotics, even though this is often unnecessary.
“We have noticed that relatively more antibiotics are prescribed to children than to the general population,” explained researcher Ruben Burvenich of KU Leuven. “This often stems from ‘diagnostic uncertainty’: it is often not easy for children to clearly explain where and what kind of pain they are feeling, which also makes it difficult for doctors to make a correct diagnosis. They then err on the side of caution and prescribe antibiotics, often unnecessarily.”
"More antibiotics are prescribed to children, often because of 'diagnostic uncertainty’"
Researchers from six Belgian universities have therefore developed a step-by-step plan for GPs and paediatricians to reduce unnecessary prescribing. In the first step, the doctor looks for three clinical signs that may indicate an increased risk of infection: a fever of at least 40 degrees Celsius, shortness of breath or the doctor's gut feeling that “something is not right”.
If one of the three signs is present, the doctor moves on to the second step: the CRP finger-prick test. The device measures the presence of the inflammation marker CRP from a drop of blood. A low value rules out a serious infection and helps to avoid unnecessary antibiotics. The third step is the “safety net advice”: parents are given clear information about which symptoms to look out for and when to contact the doctor again.
The effectiveness of this “decision tool” was tested on a large scale. A total of 6,750 children between the ages of 6 months and 12 years participated, spread across 171 medical practices throughout Belgium, representing more than 400 doctors. The practices were randomly divided into two groups: one group worked with the decision tool, while the control group provided the usual care.
In the group using the decision tool, the number of antibiotic prescriptions fell significantly to 16 per cent, compared to 22 per cent in the control group. This means that a quarter fewer prescriptions were issued. At the same time, the duration of the illness remained the same in both groups, and the children in the decision tool group did not require any additional tests, hospital admissions or follow-up consultations.
In the long term, the effects on antibiotic resistance could be significant. However, clarity is still needed on the reimbursement of the CRP rapid test and a legal framework for its use outside hospitals.
The results of the study have been published in the renowned scientific journal The Lancet. The participating universities were KU Leuven, UAntwerpen, VUB, UGent, ULiège and UCLouvain.
#FlandersNewsService | Illustration © PHOTO IMAGEBROKER
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