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Booklet reduces antibiotic prescribing for childhood fever

“Out-of-hours” family physicians — those clinicians who provided primary care between 5:00 p.m. to 8:00 a.m. daily and the entire weekend — who used an illness-focused interactive booklet, and treated children with fever, were less likely to prescribe antibiotics to these patients, according to findings recently published in Annals of Family Medicine.

“Fever is the most common reason for a child to be taken to a physician, yet the level of unwarranted antibiotic prescribing remains high,” Eefje G. P. M. de Bont, MD, MSc, department of family medicine at Maastricht University in the Netherlands and colleagues wrote. “No studies of leaflets have been performed during out-of-hours care or in childhood fever consultations.”

Researchers reviewed data from 3,518 family physicians and 25,355 patients younger than 12 years at 20 out-of-hours centers in the Netherlands. The centers were randomly assigned in a 1:1 ratio to perform care as usual or receive a booklet with information on the benefits and harms of antibiotic treatment, the natural duration of common childhood infections, paracetamol dosage schemes and advice and information on skin rash and febrile convulsions. The booklet was used in 28.5% of 11,945 consultations.

De Bont and colleagues found vs. usual care, use of the booklet significantly reduced antibiotic prescribing (OR = 0.83; 95% CI, 0.74-0.94) and children for whom the booklet was actually used were less likely to receive a prescription for any medication, including nonantibiotics (OR = 0.77; 95% CI, 0.7-0.86).

In addition, a complier-adjusted causal effect analysis showed utilization of the booklet was linked to reduced odds of antibiotic prescriptions during index consultations (OR =0.71; 95% CI, 0.63-0.79) and of any prescription during index consultations (OR = 0.62; 95% CI, 0.57-0.69). In addition, the parents of children whose family physician had access to the booklet were less likely to consult again for comparable illnesses.

“This is one of the largest cluster-randomized controlled trials ever performed in general practice and the first to assess the effectiveness of a booklet for one of the most common reasons for childhood consultations and antibiotic prescriptions,” de Bont and colleagues wrote.

“The reduction in antibiotic prescribing found in this implementation study of all children seen at out-of-hours care with fever seems modest. It provides evidence, however, of the likely real-world benefits of this intervention, and evidence of the intervention’s efficacy when used could probably increase its use. The study is therefore highly relevant to the aim of reducing antimicrobial resistance,” they added. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.