New approach can drastically reduce antibiotic prescription for children

Antimicrobial resistance is one of the greatest threats to global public health. An important cause of antimicrobial resistance is the unnecessary prescription of antibiotics, often in cases of respiratory tract infections or ear infections in children. In Belgium, nearly one in five children consulting a general practitioner when ill are prescribed an antibiotic, even though this is not always warranted.

Better framework for general practitioners

In this context, the researchers investigated whether a clear step-by-step plan for general practitioners and paediatricians could help reduce unnecessary prescribing. They developed a decision tool consisting of three components:

• Clinical decision tree: three clinical signs help general practitioners assess the likelihood of a severe infection: fever of at least 40°C, shortness of breath, or the ‘gut feeling’ that something is wrong. These elements may indicate an increased risk of a severe infection.
• CRP finger-prick test: in children with an increased risk of a severe infection or in cases where antibiotics are being considered, the general practitioner can carry out a rapid blood test. With a single drop of blood from a finger, the inflammation marker C-reactive protein (CRP) is measured within three minutes. A low value (< 5 mg/L) virtually rules out a severe infection and helps avoid the unnecessary use of antibiotics.
• Safety-netting advice: parents receive clear written and oral information about infections and specific instructions on warning signs to monitor and when to contact the general practitioner again. This actively involves them in monitoring their child’s health and helps to reassure them.

The ARON study

The effectiveness of the decision tool was tested on a large scale. In total, 6,750 children between 6 months and 12 years old participated, across 171 general practices in Belgium. The practices were randomly assigned to two groups: one group used the decision tool, the control group provided standard care.

The results are clear. In the group that used the decision tool:

• the number of antibiotic prescriptions fell significantly to 16%, compared to 22% in the control group – a reduction of one in four prescriptions;
• the recovery time for patients remained the same (average of 4.6 days);
• there were no differences in additional tests, follow-up consultations or hospital admissions;
• no serious adverse events were attributed to the decision tool.

‘With this study, we show that we can support general practitioners and paediatricians in prescribing antibiotics in a more targeted and safe way. In doing so, we make an important contribution to the fight against antimicrobial resistance,’ says prof. dr. Jan Verbakel (KU Leuven), first author of the study.

A step towards implementation

According to the researchers, the decision tool could be widely implemented in primary care. It is in line with existing guidelines and can easily be integrated into electronic patient records. The high level of compliance among participating general practitioners shows that the tool is practical.

‘The strength of this study is that we have combined several techniques into one clear approach. It is precisely the combination of the clinical decision tree, the rapid test, and effective communication with parents that makes the difference,’ says Dr Ruben Burvenich (KU Leuven, University of Tasmania), joint first author of the study.

In the context of the National Action Plan against Antimicrobial Resistance (2025–2029), the researchers hope that this Belgian study will provide valuable input for the knowledge base and implementation of appropriate antibiotic use. According to the researchers, policy-makers now have an important role to play in ensuring effective implementation of the decision tool. One of the challenges is to bring clarity regarding reimbursement of the CRP rapid test and the legal framework for its use outside the hospital context. The research team is currently mapping the long-term impact of the decision tool, including effects like cost reduction and the impact on antimicrobial resistance in a follow-up study.

More information:

• The study ‘A clinical decision tool including a decision tree, point-of-care testing of CRP, and safety-netting advice to guide antibiotic prescribing in acutely ill children in primary care in Belgium (ARON): a pragmatic, cluster-randomised, controlled trial’ by Verbakel JY, Burvenich R, et al. was published in The Lancet.
• The research was conducted by KU Leuven in cooperation with UAntwerpen, VUB, UGent, ULiège and UCLouvain.
• The research was funded by the Belgian Healthcare Knowledge Centre (KCE).
• https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01239-5/fulltext