Evidence map›Paper›PMID 29440016›Full record

Trial reportThe British journal of general practice : the journal of the Royal College of General Practitioners2018

Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions.

Marieke B Lemiengre, Jan Y Verbakel, Roos Colman, Tine De Burghgraeve, Frank Buntinx, Bert Aertgeerts, Frans De Baets, An De Sutter

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The British journal of general practice : the journal of the Royal College of General Practitioners, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Pooled it
  2. Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Marieke B LemiengreDepartment of Public Health, Ghent University, Ghent, Belgium.
Jan Y VerbakelNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, and assistant professor, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Roos ColmanDepartment of Public Health, Ghent University, Ghent, Belgium.
Tine De BurghgraeveDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Frank BuntinxDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium, and Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands.
Bert AertgeertsDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Frans De BaetsDepartment of Pediatric Pulmonology, Infection and Immune Deficiencies, Ghent University Hospital, Ghent, Belgium.
An De SutterDepartment of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAntibiotics are overprescribed for non-severe acute infections in children in primary care.

aimTo explore two different interventions that may reduce inappropriate antibiotic prescribing for non-severe acute infections. DESIGN AND

settingA cluster randomised, factorial controlled trial in primary care, in Flanders, Belgium.

methodFamily physicians (FPs) enrolled children with non-severe acute infections into this study. The participants were allocated to one of four intervention groups according to whether the FPs performed: (1) a point-of-care C-reactive protein test (POC CRP); (2) a brief intervention to elicit parental concern combined with safety net advice (BISNA); (3) both POC CRP and BISNA; or (4) usual care (UC). Guidance on the interpretation of CRP was not provided. The main outcome was the immediate antibiotic prescribing rate. A mixed logistic regression was performed to analyse the data.

resultsIn this study 2227 non-severe acute infections in children were registered by 131 FPs. In comparison with UC, POC CRP did not influence antibiotic prescribing, (adjusted odds ratio [AOR] 1.01, 95% confidence interval [CI] = 0.57 to 1.79). BISNA increased antibiotic prescribing (AOR 2.04, 95% CI = 1.19 to 3.50). In combination with POC CRP, this increase disappeared.

conclusionSystematic POC CRP testing without guidance is not an effective strategy to reduce antibiotic prescribing for non-severe acute infections in children in primary care. Eliciting parental concern and providing a safety net without POC CRP testing conversely increased antibiotic prescribing. FPs possibly need more training in handling parental concern without inappropriately prescribing antibiotics.

Indexed as

CounselingPhysicians, FamilyPoint-of-Care TestingPractice Patterns, Physicians'AdolescentAdultAnti-Bacterial AgentsBelgiumChildChild, PreschoolC-Reactive ProteinDecision Support Systems, ClinicalFamily PracticeFemaleHumansInappropriate PrescribingAnti-Bacterial AgentsC-Reactive Proteinchildrencluster randomised controlled trialinappropriate prescribingphysician–patient communicationpoint-of-care testingprimary care

Identifiers

PMID29440016
PMCPMC5819986

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.