Antibiotic stewardship using ePOCT+, a digital health clinical decision support algorithm for paediatric outpatient care: results from the DYNAMIC Tanzania cluster randomized controlled trial

Abstract Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital Clinical Decision Support Algorithm in combination with C-reactive protein test, haemoglobin test, pulse oximeter and mentorship, to guide healthcare providers in managing acutely sick children under 15 years old. To evaluate the impact of ePOCT + compared to usual care, we conducted a cluster-randomized controlled trial in Tanzanian primary care facilities (NCT05144763). Over 11 months, 23 593 consultations were included in 20 ePOCT + health facilities, and 20 713 in 20 usual care facilities. Antibiotics were prescribed in 23.2% of consultations in ePOCT + facilities, and 70.1% in usual care facilities (adjusted difference, -46.4%, 95% confidence interval (CI) -57.6 to -35.2). Day 7 clinical failure in ePOCT + facilities was non-inferior to usual care facilities (adjusted relative risk 0.97, 95% CI 0.85 to 1.10). Using ePOCT + could help address the urgent problem of antimicrobial resistance by safely reducing antibiotic prescribing. *Shared second authorship; contributed equally. **Shared last authorship; contributed equally.