• Marieke B Lemiengre, Jan Y Verbakel, Roos Colman, Tine De Burghgraeve, Frank Buntinx, Bert Aertgeerts, Frans De Baets, and An De Sutter.
• Department of Public Health, Ghent University, Ghent, Belgium.
• Br J Gen Pract. 2018 Mar 1; 68 (668): e204-e210.

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.© British Journal of General Practice 2018.

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