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Antibiotic stewardship using ePOCT+, a digital health clinical decision support algorithm for paediatric outpatient care: results from the DYNAMIC Tanzania cluster randomized controlled trial

Article scientifique 2023 Anglais

Résumé

Abstract Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital Clinical Decision Support Algorithm in combination with C-reactive protein test, haemoglobin test, pulse oximeter and mentorship, to guide healthcare providers in managing acutely sick children under 15 years old. To evaluate the impact of ePOCT + compared to usual care, we conducted a cluster-randomized controlled trial in Tanzanian primary care facilities (NCT05144763). Over 11 months, 23 593 consultations were included in 20 ePOCT + health facilities, and 20 713 in 20 usual care facilities. Antibiotics were prescribed in 23.2% of consultations in ePOCT + facilities, and 70.1% in usual care facilities (adjusted difference, -46.4%, 95% confidence interval (CI) -57.6 to -35.2). Day 7 clinical failure in ePOCT + facilities was non-inferior to usual care facilities (adjusted relative risk 0.97, 95% CI 0.85 to 1.10). Using ePOCT + could help address the urgent problem of antimicrobial resistance by safely reducing antibiotic prescribing. *Shared second authorship; contributed equally. **Shared last authorship; contributed equally.

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Tan, R., Kavishe, G., Kulinkina, A., Luwanda, L., Renggli, S., Mangu, C., Ashery, G., Jorram, M., Mtebene, I., Agrea, P., Mhagama, H., Vonlanthen, A., Faivre, V., Thabard, J., Levine, G., Pogam, M., Keitel, K., Taffé, P., Ntinginya, N., Masanja, H., D’Acremont, V. (2023). Antibiotic stewardship using ePOCT+, a digital health clinical decision support algorithm for paediatric outpatient care: results from the DYNAMIC Tanzania cluster randomized controlled trial. https://doi.org/10.21203/rs.3.rs-3084190/v1

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Auteur(s)

Rainer Tan Godfrey A. Kavishe Alexandra V. Kulinkina Lameck Luwanda Sabine Renggli Chacha Mangu Geofrey Ashery Margaret Jorram Ibrahim Evans Mtebene Peter Agrea Humphrey Mhagama Alan Vonlanthen Vincent Faivre Julien Thabard Gillian A. Levine Marie‐Annick Le Pogam Kristina Keitel Patrick Taffé Nyanda Elias Ntinginya Honorati Masanja Valérie D’Acremont

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