• Login
    View Item 
    •   UMB Digital Archive
    • UMB Open Access Articles
    • UMB Open Access Articles
    • View Item
    •   UMB Digital Archive
    • UMB Open Access Articles
    • UMB Open Access Articles
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of UMB Digital ArchiveCommunitiesPublication DateAuthorsTitlesSubjectsThis CollectionPublication DateAuthorsTitlesSubjects

    My Account

    LoginRegister

    Statistics

    Display statistics

    Improving Antibiotic Stewardship for Diarrheal Disease with Probability-Based Electronic Clinical Decision Support: A Randomized Crossover Trial

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Author
    Nelson, Eric J.
    Khan, Ashraful I.
    Keita, Adama Mamby
    Brintz, Ben J.
    Keita, Youssouf
    Sanogo, Doh
    Islam, Md Taufiqul
    Khan, Zahid Hasan
    Rashid, Md Mahbubur
    Nasrin, Dilruba
    Watt, Melissa H.
    Ahmed, Sharia M.
    Haaland, Ben
    Pavia, Andrew T.
    Levine, Adam C.
    Chao, Dennis L.
    Kotloff, Karen L.
    Qadri, Firdausi
    Sow, Samba O.
    Leung, Daniel T.
    Show allShow less

    Date
    2022-01-01
    Journal
    JAMA Pediatrics
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1001/jamapediatrics.2022.2535
    Abstract
    Importance: Inappropriate use of antibiotics for diarrheal illness can result in adverse effects and increase in antimicrobial resistance. Objective: To determine whether the diarrheal etiology prediction (DEP) algorithm, which uses patient-specific and location-specific features to estimate the probability that diarrhea etiology is exclusively viral, impacts antibiotic prescriptions in patients with acute diarrhea. Design, Setting, and Participants: A randomized crossover study was conducted to evaluate the DEP incorporated into a smartphone-based electronic clinical decision-support (eCDS) tool. The DEP calculated the probability of viral etiology of diarrhea, based on dynamic patient-specific and location-specific features. Physicians were randomized in the first 4-week study period to the intervention arm (eCDS with the DEP) or control arm (eCDS without the DEP), followed by a 1-week washout period before a subsequent 4-week crossover period. The study was conducted at 3 sites in Bangladesh from November 17, 2021, to January 21, 2021, and at 4 sites in Mali from January 6, 2021, to March 5, 2021. Eligible physicians were those who treated children with diarrhea. Eligible patients were children between ages 2 and 59 months with acute diarrhea and household access to a cell phone for follow-up. Interventions: Use of the eCDS with the DEP (intervention arm) vs use of the eCDS without the DEP (control arm). Main Outcomes and Measures: The primary outcome was the proportion of children prescribed an antibiotic. Results: A total of 30 physician participants and 941 patient participants (57.1% male; median [IQR] age, 12 [8-18] months) were enrolled. There was no evidence of a difference in the proportion of children prescribed antibiotics by physicians using the DEP (risk difference [RD], -4.2%; 95% CI, -10.7% to 1.0%). In a post hoc analysis that accounted for the predicted probability of a viral-only etiology, there was a statistically significant difference in risk of antibiotic prescription between the DEP and control arms (RD, -0.056; 95% CI, -0.128 to -0.01). No known adverse effects of the DEP were detected at 10-day postdischarge. Conclusions and Relevance: Use of a tool that provides an estimate of etiological likelihood did not result in a significant change in overall antibiotic prescriptions. Post hoc analysis suggests that a higher predicted probability of viral etiology was linked to reductions in antibiotic use.
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/19806
    ae974a485f413a2113503eed53cd6c53
    10.1001/jamapediatrics.2022.2535
    Scopus Count
    Collections
    UMB Open Access Articles

    entitlement

     
    DSpace software (copyright © 2002 - 2023)  DuraSpace
    Quick Guide | Policies | Contact Us | UMB Health Sciences & Human Services Library
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.