| Autor: |
Tan, Rainer, Kavishe, Godfrey, Luwanda, Lameck B., Kulinkina, Alexandra V., Renggli, Sabine, Mangu, Chacha, Ashery, Geofrey, Jorram, Margaret, Mtebene, Ibrahim Evans, Agrea, Peter, Mhagama, Humphrey, Vonlanthen, Alan, Faivre, Vincent, Thabard, Julien, Levine, Gillian, Le Pogam, Marie-Annick, Keitel, Kristina, Taffé, Patrick, Ntinginya, Nyanda, Masanja, Honorati, D’Acremont, Valérie |
| Zdroj: |
Nature Medicine; January 2024, Vol. 30 Issue: 1 p76-84, 9p |
| Abstrakt: |
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, hemoglobin test, pulse oximeter and mentorship, to guide health-care 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. Over 11 months, 23,593 consultations were included from 20 ePOCT+ health facilities and 20,713 from 20 usual care facilities. The use of ePOCT+ in intervention facilities resulted in a reduction in the coprimary outcome of antibiotic prescription compared to usual care (23.2% versus 70.1%, adjusted difference −46.4%, 95% confidence interval (CI) −57.6 to −35.2). The coprimary outcome of day 7 clinical failure was noninferior in ePOCT+ facilities compared to usual care facilities (adjusted relative risk 0.97, 95% CI 0.85 to 1.10). There was no difference in the secondary safety outcomes of death and nonreferred secondary hospitalizations by day 7. Using ePOCT+ could help address the urgent problem of antimicrobial resistance by safely reducing antibiotic prescribing. Clinicaltrials.gov Identifier: NCT05144763 |
| Databáze: |
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