Using technology to tackle antimicrobial resistance in acutely ill children presenting to ambulatory care
The doctoral thesis will consist of an epidemiological study, a systematic review, and a prospective field study including both quantitative and qualitative research. As the field study will make up the bulk of the thesis, it will be explained in more depth in the following paragraphs. Infections are prevalent in children and can usually be treated safely in an ambulatory setting without antibiotics. However, antibiotics are very frequently prescribed to children, which contributes to antimicrobial resistance and high care dependency. General practitioners (GPs) report diagnostic uncertainty as the reason to prescribe antibiotics. Therefore, we aim to improve the assessment of acutely ill children in primary care by means of an evidence-based diagnostic algorithm that can support GPs in their decision-making process about whether to prescribe antibiotics. A recent literature review showed that C-reactive protein (CRP) point-of-care testing (i.e. performed in the ambulatory setting) can lower the antibiotic prescription rate in children by 44%. Our survey of parents and clinicians on point-of-care CRP testing revealed that they found the test to be easy to use, but the clinicians reported the need for specific guidelines concerning the interpretation, as in clinical implications, of the test results. We propose a clinical trial where children (6 months to 12 years old) will be randomized to either of two treatment arms: (a) a diagnostic algorithm with CRP testing, safety netting, and specific guidelines on appropriate prescription of antibiotics, or (b) usual care consisting of existing evidence-based guidelines for antibiotic prescription in ambulatory care. CRP concentrations will be measured in a drop of blood following a finger prick (result in 4 minutes). Next, the clinician will inform the child/parent(s) of the result. Our aim is to recruit 6111 children. Participants’ relevant information will be obtained from their medical file and their parents. We will describe how the intervention worked in practice and how the clinicians/parents experienced the consultation. The results of this trial could change the daily medical practice of GPs and could be of great importance to parents and pediatric caregivers.