Imperial College London
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DrJethroHerberg

Faculty of Medicine, Department of Infectious Disease

Clinical Reader in Paediatric Infectious Disease
 
 
 
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j.herberg

 
 
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Location

 

231Wright Fleming WingSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Hagedoorn:2021:jac/dkab023,
author = {Hagedoorn, N and Wagenaar, J and Nieboer, D and Bath, D and von, Both U and Carrol, E and Eleftheriou, I and Emonts, M and Van, Der Flier M and de, Groot R and Herberg, J and Kohlmaier, B and Levin, M and Lim, E and Maconochie, I and Martinon-Torres, F and Nijman, R and Pokorn, M and Rivero, Calle I and Tsolia, M and Yeung, S and Zavadska, D and Zenz, W and Vermont, C and Oostenbrink, R and Moll, H},
doi = {jac/dkab023},
journal = {Journal of Antimicrobial Chemotherapy},
pages = {1349--1357},
title = {Impact of a clinical decision rule on antibiotic prescription for children with suspected lower respiratory tract infections presenting to European emergency departments: a simulation study based on routine data},
url = {http://dx.doi.org/10.1093/jac/dkab023},
volume = {76},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in children is challenging thus commonly resulting in antibiotic overuse. The Feverkidstool, a validated clinical decision rule including clinical symptoms and C-reactive protein, safely reduced antibiotic use in children at low/intermediate risk for bacterial LRTIs in a multicentre trial at emergency departments (EDs) in the Netherlands.Objectives: Using routine data from an observational study, we simulated the impact of the Feverkidstool on antibiotic prescriptions compared with observed antibiotic prescriptions in children with suspected LRTIs at 12 EDs in eight European countries.Methods: We selected febrile children aged 1 month to 5 years with respiratory symptoms and excluded upper respiratory tract infections. Using the Feverkidstool, we calculated individual risks for bacterial LRTI retrospectively. We simulated antibiotic prescription rates under different scenarios: (1) applying effect estimates on antibiotic prescription from the trial; and (2) varying both usage (50%–100%) and compliance (70%–100%) with the Feverkidstool’s advice to withhold antibiotics in children at low/intermediate risk for bacterial LRTI (≤10%).Results: Of 4938 children, 4209 (85.2%) were at low/intermediate risk for bacterial LRTI. Applying effect estimates from the trial, the Feverkidstool reduced antibiotic prescription from 33.5% to 24.1% [pooled risk difference: 9.4% (95% CI: 5.7%–13.1%)]. Simulating 50%–100% usage with 90% compliance resulted in risk differences ranging from 8.3% to 15.8%. Our simulations suggest that antibiotic prescriptions would be reduced in EDs with high baseline antibiotic prescription rates or predominantly (>85%) low/intermediate-risk children.Conclusions: Implementation of the Feverkidstool could reduce antibiotic prescriptions in children with suspected LRTIs in European EDs.
AU  - Hagedoorn,N
AU  - Wagenaar,J
AU  - Nieboer,D
AU  - Bath,D
AU  - von,Both U
AU  - Carrol,E
AU  - Eleftheriou,I
AU  - Emonts,M
AU  - Van,Der Flier M
AU  - de,Groot R
AU  - Herberg,J
AU  - Kohlmaier,B
AU  - Levin,M
AU  - Lim,E
AU  - Maconochie,I
AU  - Martinon-Torres,F
AU  - Nijman,R
AU  - Pokorn,M
AU  - Rivero,Calle I
AU  - Tsolia,M
AU  - Yeung,S
AU  - Zavadska,D
AU  - Zenz,W
AU  - Vermont,C
AU  - Oostenbrink,R
AU  - Moll,H
DO  - jac/dkab023
EP  - 1357
PY  - 2021///
SN  - 0305-7453
SP  - 1349
TI  - Impact of a clinical decision rule on antibiotic prescription for children with suspected lower respiratory tract infections presenting to European emergency departments: a simulation study based on routine data
T2  - Journal of Antimicrobial Chemotherapy
UR  - http://dx.doi.org/10.1093/jac/dkab023
UR  - https://academic.oup.com/jac/article/76/5/1349/6132078
UR  - http://hdl.handle.net/10044/1/86815
VL  - 76
ER  -
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