C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up
Introduction While lower respiratory tract infections are the main cause of death for children under 5 globally, only a small proportion of children with respiratory tract infections need antibiotics. Overuse of antibiotics globally is leading to increasing rates of antibiotic resistance. In Kyrgyzs...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/4/e066806.full |
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| author | Susanne Reventlow Volkert Siersma Talant Sooronbaev Azamat Akylbekov Elvira Isaeva Jesper Kjærgaard Anja Poulsen Rune Munck Aabenhus Jørgen Kurtzhals Joakim Bloch |
| author_facet | Susanne Reventlow Volkert Siersma Talant Sooronbaev Azamat Akylbekov Elvira Isaeva Jesper Kjærgaard Anja Poulsen Rune Munck Aabenhus Jørgen Kurtzhals Joakim Bloch |
| author_sort | Susanne Reventlow |
| collection | DOAJ |
| description | Introduction While lower respiratory tract infections are the main cause of death for children under 5 globally, only a small proportion of children with respiratory tract infections need antibiotics. Overuse of antibiotics globally is leading to increasing rates of antibiotic resistance. In Kyrgyzstan, healthcare workers regularly prescribe antibiotics when clinical uncertainty is present to err on the side of caution. Targeting antibiotic use with biomarkers of inflammation such as C reactive protein (CRP) testing at the point-of-care test (POCT) has been shown to reduce antibiotic use in general, but only few studies have been done in children and no studies exist from Central Asia. This study aims to assess whether the use of a CRP POCT can safely decrease prescription of antibiotics for children with acute respiratory symptoms in primary level healthcare centres in Kyrgyzstan.Methods and analysis Multicentre, open-label, individually randomised, controlled clinical trial with 14 days follow-up (follow-up by phone on days 3, 7 and 14) in rural lowland Chui and highland Naryn regions of Kyrgyzstan. The population are children aged 6 months to 12 years attending the primary level healthcare centres during normal business hours with acute respiratory symptoms. CRP POCT equipment will be supplied to healthcare centres, along with a short training session in CRP use, including the interpretation of results to support the clinical evaluation of the child with acute respiratory infection. The primary outcomes are the proportion of patients prescribed an antibiotic within 14 days of index consultation (superiority analysis) and days to recovery (non-inferiority analysis). Secondary outcomes are antibiotics prescribed at index consultation, reconsultations, hospital admission and vital status within 14 days. Analysis of the first primary outcome, antibiotic use, will be intention to treat using a logistic regression model. Analysis of the second primary outcome, days to recovery, will be per protocol using a linear regression model and a non-inferiority margin of 1 day.Ethics and dissemination The study was approved on 18 June 2021 by the Ethics Committee (ref: no. 1) of the National Centre of Maternity and Childhood Care, Bishkek, Kyrgyzstan. The results of the study regardless of the conclusion will be presented at international conferences and published in peer-reviewed scientific medical journals along with policy briefs and technical reports.Trial registration number NCT05195866. |
| first_indexed | 2024-04-09T18:27:34Z |
| format | Article |
| id | doaj.art-5ffb898969644c5c9023b0a0b76d827f |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-09T18:27:34Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-5ffb898969644c5c9023b0a0b76d827f2023-04-11T19:30:06ZengBMJ Publishing GroupBMJ Open2044-60552023-04-0113410.1136/bmjopen-2022-066806C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-upSusanne Reventlow0Volkert Siersma1Talant Sooronbaev2Azamat Akylbekov3Elvira Isaeva4Jesper Kjærgaard5Anja Poulsen6Rune Munck Aabenhus7Jørgen Kurtzhals8Joakim Bloch9The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkThe Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkRespiratory medicine, National Center for Cardiology and Therapy named after academician Mirsaid Mirrakhimov under the Ministry of Health of the Kyrgyz Republic, Bishkek, KyrgyzstanRespiratory Medicine, Intensive Care and Sleep Medicine Department, Republican Research Center of Pulmonology and Rehabilitation, Bishkek, KyrgyzstanDepartment of Allergology, National Centre of Maternity and Childhood Care, Bishkek, KyrgyzstanGlobal Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark1 Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, DenmarkInstitute for Public Health, University of Copenhagen, Copenhagen, DenmarkISIM, University of Copenhagen, Copenhagen, DenmarkDepartment of Clinical Microbiology, Rigshospitalet, Copenhagen, DenmarkIntroduction While lower respiratory tract infections are the main cause of death for children under 5 globally, only a small proportion of children with respiratory tract infections need antibiotics. Overuse of antibiotics globally is leading to increasing rates of antibiotic resistance. In Kyrgyzstan, healthcare workers regularly prescribe antibiotics when clinical uncertainty is present to err on the side of caution. Targeting antibiotic use with biomarkers of inflammation such as C reactive protein (CRP) testing at the point-of-care test (POCT) has been shown to reduce antibiotic use in general, but only few studies have been done in children and no studies exist from Central Asia. This study aims to assess whether the use of a CRP POCT can safely decrease prescription of antibiotics for children with acute respiratory symptoms in primary level healthcare centres in Kyrgyzstan.Methods and analysis Multicentre, open-label, individually randomised, controlled clinical trial with 14 days follow-up (follow-up by phone on days 3, 7 and 14) in rural lowland Chui and highland Naryn regions of Kyrgyzstan. The population are children aged 6 months to 12 years attending the primary level healthcare centres during normal business hours with acute respiratory symptoms. CRP POCT equipment will be supplied to healthcare centres, along with a short training session in CRP use, including the interpretation of results to support the clinical evaluation of the child with acute respiratory infection. The primary outcomes are the proportion of patients prescribed an antibiotic within 14 days of index consultation (superiority analysis) and days to recovery (non-inferiority analysis). Secondary outcomes are antibiotics prescribed at index consultation, reconsultations, hospital admission and vital status within 14 days. Analysis of the first primary outcome, antibiotic use, will be intention to treat using a logistic regression model. Analysis of the second primary outcome, days to recovery, will be per protocol using a linear regression model and a non-inferiority margin of 1 day.Ethics and dissemination The study was approved on 18 June 2021 by the Ethics Committee (ref: no. 1) of the National Centre of Maternity and Childhood Care, Bishkek, Kyrgyzstan. The results of the study regardless of the conclusion will be presented at international conferences and published in peer-reviewed scientific medical journals along with policy briefs and technical reports.Trial registration number NCT05195866.https://bmjopen.bmj.com/content/13/4/e066806.full |
| spellingShingle | Susanne Reventlow Volkert Siersma Talant Sooronbaev Azamat Akylbekov Elvira Isaeva Jesper Kjærgaard Anja Poulsen Rune Munck Aabenhus Jørgen Kurtzhals Joakim Bloch C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up BMJ Open |
| title | C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up |
| title_full | C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up |
| title_fullStr | C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up |
| title_full_unstemmed | C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up |
| title_short | C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up |
| title_sort | c reactive protein guided prescription of antibiotics for children under 12 years with respiratory symptoms in kyrgyzstan protocol for a randomised controlled clinical trial with 14 days follow up |
| url | https://bmjopen.bmj.com/content/13/4/e066806.full |
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