A large randomised controlled clinical trial of a complex intervention aimed at reducing antibiotic prescribing for children with respiratory tract infections in primary care found that the intervention, liked by GPs, neither reduced overall antibiotic prescribing nor increased hospital admissions.
Children with acute coughs and respiratory tract infections (RTIs) are the most frequent patient group seen by GPs. Most RTIs are caused by viruses but up to half of patients are treated with antibiotics. This constitutes a large amount of inappropriate antibiotic prescribing in primary care, with the risk of contributing to antimicrobial resistance, a major public health threat.
The intervention had three components: GPs asking parents about their concerns during the consultation; use of an algorithm to identify children at very low risk of hospital admission within 30 days of the consultation (in whom antibiotics might be safely withheld); and a leaflet for parents and carers explaining what to do should their child’s condition not improve or deteriorate.
The trial had an ‘efficient’ design, in that practices rather than individual patients were recruited with the help of the NIHR Clinical Research Network, and primary outcomes were measured using data routinely collected by Clinical Commissioning Groups (now Integrated Care Boards) and Public Health England (now the UK Health Security Agency), rather than going through individual patient records. This design was used to reduce the burden on practice staff and was found to be both a feasible method of conducting a trial in primary care and good value for money.
Although overall the intervention was not effective in reducing antibiotic prescribing, sub-group analyses suggest that the intervention might have been more effective pre-pandemic; in older children; in affluent or single site GP practices; and those with fewer prescribing nurses.
Paper: Blair PS et al. (2023). Multi-faceted intervention to improve management of antibiotics for children presenting to primary care with acute cough and respiratory tract infection (CHICO): efficient cluster randomised controlled trial. BMJ.
Read the full NIHR Centre for Academic Primary Care (CAPC) news item: http://www.bristol.ac.uk/primaryhealthcare/news/2023/chico-study-results.html