Could consulting an algorithm help doctors prescribe fewer unnecessary antibiotics?

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An algorithm-based digital tool could help doctors treat sick children without prescribing unnecessary antibiotics, according to international researchers who say their tool could help curb the growing problem of antibiotic resistance. The algorithm uses the results of basic tests to provide advice on potential treatments, and the researchers tested it across 20 Tanzanian health facilities, with doctors consulting the tool during paediatric consultations. The researchers say when the tool was used, antibiotics were prescribed in 23.2% of consultations, compared to 70.1% of consultations where the tool was not used. The researchers say there was no difference in treatment success depending on whether the tool was used, meaning the algorithm was able to reduce antibiotic use without causing harm.

Journal/conference: Nature Medicine

Link to research (DOI): 10.1038/s41591-023-02633-9

Organisation/s: University of Lausanne, Switzerland

Funder: This work was supported by a grant from the
Fondation Botnar, Switzerland (grant number 6278) (V.D.A.) and from
the Swiss Development Cooperation (project number 7F-10361.01.01)
(V.D.A.). The study sponsor (Centre for Primary Care and Public Health,
Unisanté, University of Lausanne) led the study design, the writing of
the report and the decision to submit the article for publication. The
funders of the study had no role in study design, data collection, data
analysis, data interpretation or writing of the report.

Media release

From: Springer Nature

Medical research: Algorithm-based consultations reduces antibiotic prescriptions in paediatrics

The use of a digital decision support tool decreased antibiotic prescriptions to children by substantial margins, with no effect on clinical outcomes, in a large cluster randomized trial in Tanzania, a paper published in Nature Medicine indicates.

Bacterial antimicrobial resistance was responsible for an estimated 1.27 million deaths in 2019, with the highest burden in sub-Saharan Africa. Antibiotic overuse is one of the major causes of increasing resistance rates among pathogens, and the use of antibiotics has been consistently rising in the past few decades. Previous studies have shown that many consultations result in prescription of antibiotics when there is no need for them.

Rainer Tan and colleagues developed a clinical decision support algorithm for paediatric consultations that uses point-of-care tests to provide advice on diagnoses and related therapies according to WHO guidelines. The authors test the tool’s efficacy in reducing antibiotic prescriptions in 20 health facilities in Tanzania, which included more than 20,000 consultations over the course of 11 months. When the tool was used, antibiotics were prescribed in 23.2% of consultations, compared to prescriptions in 70.1% of consultations in health facilities where the tool was not deployed. The reduction in prescriptions did not result in adverse effects for the patients, as no difference in the failure of treatment rate was observed during the study. 

The authors note that 25% of the individuals in the intervention arm were not managed by the algorithm, which highlights the need for consistent use of the tool. However, they note that this research represents a potentially scalable solution, in terms of cost and technology, to reduce antibiotic prescriptions safely. 


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