Impact of Clinical Guidance & Point-of-care CRP in Children: the ARON Project

Impact of clinical guidance \& point-of-care CRP test in children: the ARON project Trial Design: multicentre, cluster-randomized, parallel group pragmatic trial Trial Participants and setting: Children aged 6 months to 12 years of age with an acute illness episode presenting to in-hours general practice or out-of-hospital community paediatrics offices Intervention(s) Diagnostic algorithm: 1. Clinical decision tree: clinician's gut feeling something is wrong, dyspnea, temperature ≥40ºC 2. YES to any : point-of-care CRP ≥5mg/L: additional testing or refer to secondary care \<5mg/L: safety netting\*, only prescribe antibiotics if advised (guidelines) 3. NO to all : are AB considered? YES : point-of-care CRP ≥5mg/L: safety netting\*, only prescribe antibiotics if advised (guidelines) \<5mg/L: safety netting\*, do not prescribe antibiotics NO: safety netting \*safety netting advice: * inform parents on what to expect and what to look out for * interactive parent information booklet based on previous research Control: Diagnosis and Treatment/Management as per usual care: \- guidance on AB prescribing: o Belgische Commissie voor de Coördinatie van het Antibioticabeleid (BAPCOC) guide (updated November 2019) o RIZIV consensus meeting report "Antibiotics in children in ambulatory care" Primary Endpoint: Antibiotic prescribing rate at index consultation Secondary Endpoint(s) \- time until full clinical recovery (during follow up (day 1 to day 30)) \- additional investigations (at index consultation and/or during follow up (day 1 to day 30)) \- re-consultation (during follow up (day 1 to day 30)) \- antibiotic prescribing rate (during follow up (day 1 to day 30)) Exploratory endpoints at the index consultation: * additional investigations (X-Ray, blood tests, urine tests, etc.) During a follow-up period (day 1 to day 30): \- referral to hospital \- additional investigations (X-Ray, blood tests, urine tests