The impact of interventions to modify antibiotic use in children with suspected infections in ambulatory healthcare settings in LMICs: a systematic review
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Antimicrobial resistance (AMR) is a growing threat to child health in low- and middle-income countries (LMIC), where inadequate antibiotic access frequently causes
morbidity and mortality.
Aim
To identify effective interventions to optimise antibiotic use in children with suspected infections in LMIC ambulatory healthcare settings.
Methods
Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Infectious Disease Group Specialized Register, Web of Science, PsycInfo, WHO library database (WHOLIS) and regional databases (inception until 16th December 2024) were searched to identify studies of interventions to optimise
antibiotic use in children in LMIC peripheral healthcare settings.
Results
Our search identified 7154 articles post de-duplication; 23 studies met the inclusion and Integrated quality Criteria for the Review of Multiple Study designs (ICROMS) assessment criteria. Seventeen were randomised trials, conducted in five LMICs,
four UMICs and two LICs. Single-intervention studies investigated electronic algorithms (n=3) and point-of-care tests (POCTs) (n=4). Electronic algorithms and
enhanced POCTs reduced antibiotic prescriptions for children with acute illness at primary care facilities in Tanzania. C-reactive protein POCTs achieved modest
reductions in antibiotic prescribing for children in Vietnam and Uganda but did not for those with febrile illness in Myanmar and Thailand. A diagnostic tool algorithm showed reduction of antibiotic prescriptions in Ghana and Burkina Faso, but not in Uganda.
Conclusions
Initial evidence suggests that algorithmic decision-support tools combined with point of-care diagnostics and provider education can reduce antibiotic prescribing in children attending ambulatory healthcare settings in LMICs, with most studies demonstrating no compromise of clinical outcomes. However, few studies assessed
prescription appropriateness or microbiological outcomes, limiting conclusions about long-term impact. Future interventions should prioritise context-adaptable strategies that incorporate rapid diagnostics, evaluate clinical and appropriateness outcomes, and consider implementation feasibility across diverse LMIC settings.
Antimicrobial resistance (AMR) is a growing threat to child health in low- and middle-income countries (LMIC), where inadequate antibiotic access frequently causes
morbidity and mortality.
Aim
To identify effective interventions to optimise antibiotic use in children with suspected infections in LMIC ambulatory healthcare settings.
Methods
Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Infectious Disease Group Specialized Register, Web of Science, PsycInfo, WHO library database (WHOLIS) and regional databases (inception until 16th December 2024) were searched to identify studies of interventions to optimise
antibiotic use in children in LMIC peripheral healthcare settings.
Results
Our search identified 7154 articles post de-duplication; 23 studies met the inclusion and Integrated quality Criteria for the Review of Multiple Study designs (ICROMS) assessment criteria. Seventeen were randomised trials, conducted in five LMICs,
four UMICs and two LICs. Single-intervention studies investigated electronic algorithms (n=3) and point-of-care tests (POCTs) (n=4). Electronic algorithms and
enhanced POCTs reduced antibiotic prescriptions for children with acute illness at primary care facilities in Tanzania. C-reactive protein POCTs achieved modest
reductions in antibiotic prescribing for children in Vietnam and Uganda but did not for those with febrile illness in Myanmar and Thailand. A diagnostic tool algorithm showed reduction of antibiotic prescriptions in Ghana and Burkina Faso, but not in Uganda.
Conclusions
Initial evidence suggests that algorithmic decision-support tools combined with point of-care diagnostics and provider education can reduce antibiotic prescribing in children attending ambulatory healthcare settings in LMICs, with most studies demonstrating no compromise of clinical outcomes. However, few studies assessed
prescription appropriateness or microbiological outcomes, limiting conclusions about long-term impact. Future interventions should prioritise context-adaptable strategies that incorporate rapid diagnostics, evaluate clinical and appropriateness outcomes, and consider implementation feasibility across diverse LMIC settings.
Date Issued
2026-06-01
Date Acceptance
2026-05-28
Citation
JAC-Antimicrobial Resistance, 2026, 8 (3)
ISSN
2632-1823
Publisher
Oxford University Press
Journal / Book Title
JAC-Antimicrobial Resistance
Volume
8
Issue
3
Copyright Statement
© The Author(s) 2026. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/ by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1093/jacamr/dlag109
Publication Status
Published
Article Number
ARTN dlag109
Date Publish Online
2026-06-13