Bacterial antimicrobial resistance (AMR) was responsible for 1.27 million deaths in 2019, with the highest burden in sub-Saharan Africa. In Tanzania and many resource-constrained countries, more than 50% of sick children receive antibiotics when visiting a health facility, with 80–90% of such antibiotics prescribed at the outpatient level and most deemed inappropriate.

Researchers from the Ifakara Health Institute, the Mbeya Medical Research Centre, the Swiss Tropical and Public Health Institute and the Center for Primary Care and Public Health of the University of Lausanne have 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, they 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. The coprimary outcome of day 7 clinical failure was noninferior in ePOCT+ facilities compared to usual care facilities. 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.

Article written by| Image by Unsplash