For physicians using a smartphone-based clinical decision-support tool, incorporating an algorithm aimed at estimating the probability that diarrhea is due to a viral cause failed to reduce antibiotic prescribing, a randomized crossover trial conducted in Mali and Bangladesh found.
In the study of more than 900 children with acute diarrhea, no significant difference was observed in the proportion of children receiving antibiotics when physicians used the algorithm versus when they did not (69.8% vs 76.5%; risk difference [RD] -4.2%, 95% CI -10.7 to 1.0), reported Eric Nelson, MD, PhD, of the University of Florida in Gainesville, and colleagues in JAMA Pediatrics.
However, a post hoc analysis that assessed antibiotic prescribing when the diarrheal etiologic prediction (DEP) algorithm pointed to viral etiology showed potential benefit (RD -5.6%, 95% CI -12.8 to -10). A 14% drop in the likelihood of antibiotic prescribing for the DEP group was seen for every 10% increase in the predicted probability of viral diarrhea (OR 0.86, 95% CI 0.76-0.96).
“If replicated, the use of etiological prediction in decision support tools represents an important advancement to improve antibiotic stewardship in a clinical context prone to high rates of inappropriate antibiotic use,” the researchers concluded.
Overuse of antibiotics can lead to antimicrobial resistance and put children at risk for adverse events, Nelson’s group noted. But many children in lower-income nations are exposed to antibiotics for viral diarrhea despite recommendations from the World Health Organization that use of antibiotics should be reserved for pediatric diarrhea cases involving a suspicion of cholera, or for bloo