Choice-support instrument might cut back pointless antibiotic prescriptions for baby diarrhoea

A decision support tool accessible on mobile devices can help doctors in less resourceful environments avoid unnecessary antibiotic prescriptions for children with diarrhea, a study published today in eLife shows.

Preliminary results suggest that incorporating real-time environmental, epidemiological and clinical data into an easily accessible electronic tool could help clinicians adequately manage children with diarrhea, even when tests are not available. This could help avoid the overuse of antibiotics, which contributes to the creation of drug-resistant bacteria.

“Diarrhea is a common condition among children in resource-poor environments,” explains lead author Benjamin Brintz, a research fellow at the Epidemiology Department at the University of Utah Health in Salt Lake City, USA. “Antibiotics are often prescribed for this, although these drugs do not help patients with virus-induced diarrhea. If doctors can determine whether diarrhea is likely caused by a virus or bacteria, inappropriate antibiotic prescriptions can be reduced.”

In their study, Brintz and colleagues developed a statistical model that integrated multiple real-time sources of data to help doctors determine whether a child’s diarrhea was caused by bacteria or viruses. This included information about previous patients, the time of year, and the weather, which is useful as some viruses are seasonal and certain bacterial infections can be transmitted through flooding or similar conditions.

To accommodate disruptions in electronic information sources, which can be common in some environments, the team built the model so that it would work even if some information was missing. They’ve also optimized it for use on mobile devices. They then tested how well the model would work when applied to real-life diarrhea in pediatric patients. Their results showed that it could reduce inappropriate antibiotic prescriptions by more than 50%.

The authors say the next step in their research will be to ensure that the tool is safe enough that doctors can trust it, and that it doesn’t result in under-treating patients who need antibiotics. If this decision aid can meet these high standards, it could be a valuable resource for clinicians with limited diagnostic tools who often only rely on their best professional judgment.

“The global burden of diarrhea is highest in low- and middle-income countries, where access to laboratory testing is restricted,” concludes Senior Author Daniel Leung, Associate Professor of Internal Medicine (Infectious Diseases) and Associate Professor of Pathology (Microbiology and Immunology) from the University of Utah Health. “The care of children in these regions could benefit greatly from an accurate and flexible decision-making tool.”



The paper, “A Modular Approach to Integrating Multiple Data Sources into Real-Time Clinical Prediction for Pediatric Diarrhea” is available free of charge online at Content, including text, images and data, can be reused under a CC BY 4.0 license.

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