Impact of a diagnostic algorithm with a point-of-care C-reactive protein test, with clinical decision support and safety net advice on the prescription of antibiotics and the further treatment of acutely ill children in outpatient care: a multicenter, cluster-randomized, pragmatic study with parallel groups (ARON)

Children get infections regularly, and these can usually be treated safely on an outpatient basis without antibiotics. However, many children are prescribed antibiotics, which contribute to antimicrobial resistance and a higher dependence on care. GPs often cite diagnostic uncertainty as a reason for prescribing antibiotics. We therefore want to strengthen the assessment of acutely ill children in primary care with an evidence-based diagnostic algorithm that can support general practitioners in their decision not to prescribe antibiotics. A recent literature review showed that C-reactive protein (CRP) as a point-of-care test, (i.e., performed in general practice), can reduce the number of antibiotic prescriptions by up to 44% in children. We questioned parents and clinicians about point-of-care CRP. They found the test useful, but the doctors reported that they needed specific guidelines explaining how to handle the test result. Here we propose a clinical study in which children (6 months to 12 years) are randomly assigned and treated either on the basis of (a) a diagnostic algorithm, with CRP testing, safety net advice and specific guidelines on responsible antibiotic prescribing. or (b) usual care, using existing evidence-based guidelines for prescribing antibiotics in outpatient care. The CRP level is measured from a drop of blood after a finger prick (result within 4 minutes). The doctor then communicates the result to the child / parents. Our goal is to recruit 6111 children. Their data is obtained from their medical record and directly from the parents. We will describe how the intervention worked in practice and how doctors / parents experienced the consultation. The findings of this study can change the daily practice of the GP and can be of great interest to parents and pediatric caregivers.