Photo: Magali RochatA large-scale study by the DYNAMIC project has produced promising results: the use of a new digital clinical decision-making tool has led to a twoto three-fold reduction in the prescription of antibiotics. These results, just published in the peer-reviewed journal Nature Medicine, marks an important step towards curbing bacterial antimicrobial resistance.
The DYNAMIC project focuses on improving care for sick children aged 0-14 presenting to care at primary care level health facilities in lowand middle-income countries. A team of Swiss and Tanzanian medical and IT experts from Unisanté, the Swiss Tropical and Public Health Institute, the Ifakara Health Institute and the National Institute of Medical Research, continued to developed ePOCT+, which combines a clinical decision support algorithm with a number of key rapid diagnostic tests. This tool guides healthcare providers through the consultation process, encouraging them to assess symptoms and signs, carry out tests if necessary, and finally propose a diagnosis and appropriate treatment. All of this is supported by a mentoring strategy for clinicians based on the visualisation of their own monthly drug prescriptions.
Promising results in the fight against the over-prescription of antibiotics
As part of a cluster randomized controlled trial in Tanzania involving 44,306 children, ePOCT+ was deployed in 20 health facilities, while 20 health facilities provided care as usual. The results speak for themselves: the use of ePOCT+ led to a considerable reduction in the prescription of antibiotics. When the tool was deployed, antibiotics were prescribed in 23.2% of consultations, compared to prescriptions in 70.1% of consultations when the tool was not used. It is essential to note that this reduction in the prescription of antibiotics did not lead to an increase in clinical failures on day 7 compared to children managed in health facilities not using ePOCT+. In addition, no trend towards a deleterious impact was observed in terms of deaths and hospitalizations up to day 7.
The urgent need for action
Bacterial antimicrobial resistance was responsible for 1.27 million deaths in 2019, as much as malaria and HIV combined. Inappropriate use of antibiotics is a major factor in this problem. In Tanzania, the majority of sick children receive antibiotics during a consultation, even though 80-90% of these prescriptions are unnecessary and even harmful, due to their destructive effect on the intestinal flora. This study therefore represents a significant step forward in the fight against antimicrobial resistance, which is all the more urgent now that new antibacterial agents are becoming increasingly rare.
Promising prospects for expanded use
Although the results of this study are encouraging, the research team is continuing to work to ensure that these results hold true in less controlled conditions and to try to improve and extend the use of ePOCT+. The aim is to understand which algorithm branches are most useful in order to simplify it, and to understand why some healthcare providers are not yet using it, or are not using it correctly. The publication in Nature Medicine is an important milestone that could encourage wider adoption of this or a similar tool. Paving the way for safer, more effective care for patients in Tanzania and beyond.
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