In English primary care practices, a multifaceted antibiotic stewardship intervention was not effective for improving prescribing patterns or outcomes in children aged 0 to 9 years, a study shows. “Evidence suggested that in some subgroups and situations (for example, under non-pandemic conditions) the intervention slightly reduced prescribing rates but not in a clinically relevant way,” the authors concluded.
Using a 2-arm design with cluster randomization of general practices, the investigators identified children aged 0-9 years presenting with respiratory tract infection at 294 general practices before and during the COVID-19 pandemic. The intervention included elicitation of parental concerns during the consultation; a clinician-focused prognostic algorithm to identify children at very low, normal, or elevated 30-day risk of hospital admission accompanied by antibiotic prescribing guidance; and a leaflet for carers that included safety netting advice on when to seek medical care or alert physicians.
Based on the rate of dispensed amoxicillin and macrolide antibiotics (superiority comparison) and hospital admissions for respiratory tract infection (noninferiority comparison) over a 12-month period, the study found: “Median intervention use per practice was 70 (by a median of 9 clinicians). No evidence was found that antibiotic dispensing differed between intervention practices (155 (95% confidence interval 138 to 174) items/year/1000 children) and control practices (157 (140 to 176) items/year/1000 children) (rate ratio 1.011, 95% confidence interval 0.992 to 1.029; P = 0.25). Pre-specified subgroup analyses suggested reduced dispensing in intervention practices with fewer prescribing nurses, in single site (compared with multisite) practices, and in practices located in areas of lower socioeconomic deprivation, which may warrant future investigation. Pre-specified sensitivity analysis suggested reduced dispensing among older children in the intervention arm (P = 0.03). A post hoc sensitivity analysis suggested less dispensing in intervention practices before the pandemic (rate ratio 0.967, 0.946 to 0.989; P = 0.003). The rate of hospital admission for respiratory tract infections in the intervention practices (13 (95% confidence interval 10 to 18) admissions/1000 children) was non-inferior compared with control practices (15 (12 to 20) admissions/1000 children) (rate ratio 0.952, 0.905 to 1.003).”