Background: Fever is common in children and often self-limiting, nevertheless antibiotics are frequently prescribed. We determined how often antibiotics were prescribed in children presenting with fever at a family physicians' out-of-hours service and established the children's signs and symptoms related to antibiotic prescriptions.Patients: Children aged 3 months to 6 years with fever as the main reason for contact. Results: Of the 443 included children, 322 children had a face-to-face contact at the out-of-hours service. Of these, 117 (36.3%) were prescribed antibiotics, that is, 26.5% of the total study population.

This trial with three parallel treatment groups shows that INCS daily was not superior to INCS on demand or to antihistamine on demand regarding the number of symptom-free days. An on-demand INCS strategy has the advantage of a lower overall corticosteroid exposure and less costs.

PURPOSE Fever is the most common reason for a child to be taken to a physician, yet the level of unwarranted antibiotic prescribing remains high. We aimed to determine the effect on antibiotic prescribing of providing an illness-focused interactive booklet on fever in children to out-of-hours primary care clinicians. METHODSWe conducted a cluster-randomized controlled trial in 20 out-ofhours general practice centers in the Netherlands. Children aged younger than 12 years with fever were included. Family physicians at the 10 intervention sites had access to an illness-focused interactive booklet between November 2015 and June 2016. The primary outcome was antibiotic prescribing during the index consultation. Analysis was performed by fitting 2-level random intercept logistic regression models. RESULTSThe trial took place among 3,518 family physicians and 25,355 children. The booklet was used in 28.5% of 11,945 consultations in the intervention group. Compared with usual care, access to the booklet did not significantly alter antibiotic prescribing during the index consultation (odds ratio = 0.90; 95% CI, 0.79-1.02; prescription rate, 23.5% vs 25.2%; intracluster correlation coefficient = 0.005). In contrast, use of the booklet significantly reduced antibiotic prescribing (odds ratio = 0.83; 95% CI, 0.74-0.94; prescription rate, 21.9% vs 25.2%; intracluster correlation coefficient = 0.002). Children managed by family physicians with access to the booklet were less likely to receive any drug prescription, and parents in the booklet group showed a reduced intention to consult again for similar illnesses.CONCLUSIONS Benefit of an illness-focused interactive booklet in improving outcomes of childhood fever in out-of-hours primary care was largely restricted to the cases in which family physicians actually used the booklet. Insight into reasons for use and nonuse may inform future interventions of this type. Ann Fam Med 2018;16:314-321. https://doi.org/10.1370/afm.2265. INTRODUCTIONF ever is the most common reason for a child to be taken to a physician, and most fever consultations take place in general practice.1 As many parents work during the day and fever typically rises in the early evening, these rates are even higher during out-of-hours care.1,2 In most cases, fever is caused by benign viral infections, and general recommendations given by a family physician are sufficient for management. One in every 3 to 4 children who visit family physician out-of-hours care with a fever receives an antibiotic prescription, however. 4,5 These prescription rates are nearly twice as high as those during routine office hours. 6 Consultations are generally driven by parental concerns about harmful consequences of fever. These concerns can be more prominent when needing to consult a family physician on call who is not their personal family physician. 7Previous studies have shown that antibiotic prescribing is strongly influenced by patients' expectations and that family physicians experience pressure from patients to presc...

General practitioners stand at the front line of healthcare provision and have a pivotal role in the fight against increasing antibiotic resistance. In this respect, targeted antibiotic prescribing by general practitioners would help reduce the unnecessary use of antibiotics, leading to reduced treatment failures, fewer side-effects for patients and a reduction in the (global) spread of antibiotic resistances. Current ‘gold standard’ antibiotic resistance detection strategies tend to be slow, taking up to 48 h to obtain a result, although the implementation of point-of-care testing by general practitioners could help achieve the goal of targeted antibiotic prescribing practices. However, deciding on which antibiotic resistances to include in a point-of-care diagnostic is not a trivial task, as outlined in this publication.