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GP risk tool for child RTIs ‘could help reduce antibiotic prescribing by 10%’

Researchers have designed a tool to help GPs to determine which children with coughs and respiratory tract infections are most at risk of hospitalisation to reduce unnecessary antibiotic prescribing, a paper published in the Lancet Respiratory Medicine has revealed.

According to the authors, this could reduce antibiotics prescribed to children by 10%, although GP leaders warn that this is ‘no substitute for careful clinical judgement’.

The researchers led by scientists from the Centre for Academic Primary Care at the University of Bristol, found seven characteristics that GPs could use to identify children at varying levels of risk of hospitalisation from cough and RTI, with the mnemonic STARWAVe: short (≤3 days) illness; high temperature; age (<24 months); recession; wheeze; asthma; and vomiting. Risk of hospitalisation increases with the number of characteristics present.

The study looked at 8,390 children from 224 GP practices and found that there was a 1% risk of hospitalisation following an RTI overall.

With none or one of these characteristics, the risk of hospitalisation was only 0.3%, whereas with two or three characteristics it increased to 1.5%. With four or more symptoms, the risk was up to 12%.

They recommended GPs should prescribe no antibiotics or delayed antibiotic treatment strategy for low or normal risk children – those with three or fewer of the characteristics.

Professor Alastair Hay, a GP and professor of primary care at the University of Bristol, who led the study, said that the tool will better inform decisions about when to prescribe antibiotics.

He said: ‘We believe use of this algorithm could represent a step-change in the care of children with coughs and respiratory tract infections in primary care. We all know we need to curb the excessive use of antibiotics, but safely reducing prescribing means improving our identification of the patients who do and don’t need them.

‘To our knowledge, this is the first time anyone has produced evidence that could be used to help hard-pushed, front-line clinicians make better antibiotic prescribing decisions.’

But Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, told Pulse that the tool will need ‘proper evaluation’ before use.

‘We have seen a proliferation of scoring systems recently and although they can help the inexperienced they are no substitute for careful clinical judgement, and the danger is that clinicians might place more faith in them than they deserve, using them to “over-rule” their better instincts.

‘If a scoring system exists, GPs may fear criticism for not using it, or for not following its conclusions, even though the inevitable false positive and negative rates of all tools mean that ignoring them is often the correct thing to do.

‘With respect to this particular tool, hospitalisation is dependent on many variables and as such is a rather imprecise marker for the genuine need for antibiotics.’

This comes after GPs have been praised for a dramatic fall in antibiotic prescribing, although other research has found that GPs who prescribe fewer antibiotics get worse patient satisfaction scores



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