Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
J Antimicrob Chemother. 2018 May 1;73(5):1416-1422. doi: 10.1093/jac/dkx542.
Antibiotics are too often prescribed in childhood respiratory tract infection (RTI), despite limited effectiveness, potential side effects and bacterial resistance. We aimed to reduce antibiotic prescribing for children with RTI by online training for general practitioners (GPs) and information for parents.
A pragmatic cluster randomized controlled trial in primary care. The intervention consisted of online training for GPs and an information booklet for parents. The primary outcome was the antibiotic prescription rate for children presenting with RTI symptoms, as registered by GPs. Secondary outcomes were number of reconsultations within the same disease episode, consultations for new episodes, hospital referrals and pharmacy-dispensed antibiotic courses for children. This trial was registered at the Dutch Trial Register (NTR), registration number: NTR4240.
After randomization, GPs from a total of 32 general practices registered 1009 consultations. An antibiotic was prescribed in 21% of consultations in the intervention group, compared with 33% in the usual care group, controlled for baseline prescribing (rate ratio 0.65, 95% CI 0.46-0.91). The probability of reconsulting during the same RTI episode did not differ significantly between the intervention and control groups, and nor did the numbers of consultations for new episodes and hospital referrals. In the intervention group antibiotic dispensing was 32 courses per 1000 children/year lower than the control group, adjusted for baseline prescribing (rate ratio 0.78, 95% CI 0.66-0.92). The numbers and proportion of second-choice antibiotics did not differ significantly.
Concise, feasible, online GP training, with an information booklet for parents, showed a relevant reduction in antibiotic prescribing for children with RTI.
尽管抗生素的疗效有限、存在潜在副作用且易产生细菌耐药性，但在儿童呼吸道感染（RTI）的治疗中，抗生素仍被过度开具。本研究旨在通过对全科医生（GP）进行在线培训和向家长提供信息，减少儿童 RTI 患者的抗生素处方。
这是一项在初级保健中开展的实用型集群随机对照试验。干预措施包括对 GP 进行在线培训和为家长提供信息手册。主要结局是 GP 记录的儿童 RTI 症状就诊患者的抗生素处方率。次要结局是同一疾病发作内的复诊次数、新发作的就诊次数、医院转诊和儿童的药房配药抗生素疗程。本试验在荷兰试验注册处（NTR）注册，注册号为 NTR4240。
在随机分组后，共有 32 家普通诊所的 GP 登记了 1009 次就诊。干预组中，抗生素处方率为 21%，而对照组为 33%，校正基线处方率后，差异有统计学意义（率比 0.65，95%CI 0.46-0.91）。干预组和对照组在同一 RTI 发作期间的复诊概率无显著差异，新发作的就诊次数和医院转诊也无显著差异。干预组的抗生素配药量比对照组低 32 个疗程/1000 名儿童/年，校正基线处方率后差异有统计学意义（率比 0.78，95%CI 0.66-0.92）。第二选择抗生素的数量和比例无显著差异。
简洁、可行的在线 GP 培训，辅以家长信息手册，可显著减少儿童 RTI 患者的抗生素处方。
