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To reduce antibiotic prescription
Research project  |  Dr. R. Oostenbrink

To reduce antibiotic prescription in children suspected of pneumonia (STRAP)

Status: Ongoing

This is a study using a prediction rule for children with fever that estimates the risk of pneumonia and/or bacterial infections, to guide decisions upon antibiotic prescription.

What we do

About our project

Background information 

Community-acquired pneumonia (CAP) is the single largest cause of death in children worldwide. In developed countries the numbers of  under 5 year olds dying from CAP exceed those dying from meningitis and other infectious causes. CAP is among the most frequent diagnoses in children with fever.

An estimated 30% (> 5 years) - 80% (< 2 years) of childhood CAP in western countries is caused by viruses. Prescription of (often broad-spectrum) antibiotics for childhood CAP in practice still varies widely.

So we are in need to improve the recognition of those children that benefit from antibiotic treatment for bacterial causes of CAP.

Overall aim

We recently developed and broadly validated a prediction rule for children with fever that estimates the risk of pneumonia and of other serious bacterial infections for individual children. The rule is based on clinical characteristics, vital signs and serum CRP.

The aim of this study is to reduce antibiotic prescriptions by use of a clinical decision rule in febrile children suspected for CAP, with unchanged outcome.

Primary objective

Does a decision rule safely reduce unnecessary antibiotic prescriptions in children with CAP?

Secondary objective

What is the compliance to a decision rule guiding clinicians on treatment for childhood CAP?

Research method 

A phased implementation trial (stepped wedge design) of a clinical decision rule that advises on antibiotic treatment in febrile children suspected of community acquired pneumonia.

STRAP logo

Desirable outcome

Number of narrow-spectrum antibiotic prescriptions: We will classify antibiotic prescriptions according to the Anatomical Therapeutic Chemical (ATC) classification system. Drugs listed under J01CE (beta lactam sensitive penicillins) are considered the antibiotics of choice in CAP. We will compute the ratio between the number of broad spectrum penicillins, cephalosporins and macrolides and the number of narrow spectrum antibiotics.


Collaborations outside of Erasmus MC