@article {Lemiengrebjgp18X695033, author = {Marieke B Lemiengre and Jan Y Verbakel and Roos Colman and Tine De Burghgraeve and Frank Buntinx and Bert Aertgeerts and Frans De Baets and An De Sutter}, title = {Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions}, elocation-id = {bjgp18X695033}, year = {2018}, doi = {10.3399/bjgp18X695033}, publisher = {Royal College of General Practitioners}, abstract = {Background Antibiotics are overprescribed for non-severe acute infections in children in primary care.Aim To explore two different interventions that may reduce inappropriate antibiotic prescribing for non-severe acute infections.Design and setting A cluster randomised, factorial controlled trial in primary care, in Flanders, Belgium.Method Family 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.Results In 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.Conclusion Systematic 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.}, issn = {0960-1643}, URL = {https://bjgp.org/content/early/2018/02/14/bjgp18X695033}, eprint = {https://bjgp.org/content/early/2018/02/14/bjgp18X695033.full.pdf}, journal = {British Journal of General Practice} }