A digital clinical decision support algorithm was associated with reduced antibiotic prescribing in pediatric outpatient settings in Rwanda, according to a pragmatic cluster non-randomized controlled trial published in PLOS Medicine.
Inappropriate antibiotic use in outpatient care contributes to antimicrobial resistance, particularly in low-resource settings where access to laboratory diagnostics is limited. The study evaluated whether integrating a digital algorithm into routine pediatric care could improve adherence to prescribing guidelines for acutely ill children.
The trial was conducted in 32 public health centers in Rwanda and included children aged 14 years or younger presenting with acute illness during outpatient visits. Facilities using the digital decision support tool were compared with facilities providing standard care.
The algorithm, known as ePOCT+, guided clinicians through structured clinical assessments and incorporated point-of-care tests to support diagnosis and antibiotic prescribing decisions aligned with national and Integrated Management of Childhood Illness guidelines.
The primary outcome was the proportion of children prescribed oral or parenteral antibiotics at the initial consultation. Secondary outcomes included referral recommendations, malaria testing among febrile patients, and clinical outcomes at follow-up.
Across nearly 60,000 pediatric consultations, antibiotic prescribing fell substantially in facilities using the digital tool. Prescriptions were given in about 25% of consultations compared with roughly 71% under standard care, while recovery outcomes remained similar between groups.
Follow-up assessments did not show evidence that reduced antibiotic use compromised clinical recovery, suggesting that fewer prescriptions did not worsen outcomes for children treated using the algorithm.
The study was designed to reflect real-world implementation. Health facilities were assigned to intervention or control groups without randomization, and analyses accounted for clustering at the facility level. The authors noted that the non-randomized design and possible differences between facilities may limit the strength of causal conclusions.
Overall, the study concluded that digital clinical decision support may help improve antibiotic stewardship in pediatric outpatient care, particularly in settings with limited diagnostic resources. Further evaluation in other health systems and assessment of long-term impact on antimicrobial resistance were recommended.
Source: PLOS Medicine.