CHICO – RCT to reduce antibiotic prescribing among CHIldren with COugh

CHICO was an NIHR HTA funded cluster randomised controlled trial from 2018 to 2022. The intervention included an algorithm to predict the risk of hospitalisation among children who present with cough or upper respiratory tract infection, the clinician addressing carer concerns and a personalised leaflet of the consultation to give to the carer. 

 

CACH Team: Peter Blair, Jenny Ingram,

The intervention did not reduce overall antibiotic dispensing in children presenting with a cough although the evidence suggested that in some subgroups under non-pandemic conditions dispensing rates were reduced (but not enough to be clinically relevant). For this study we adopted an efficient design using  routinely collected dispensing data as a primary outcome demonstrating this is a viable approach for primary care research. Clinicians found the CHICO intervention useful to support decision making around antibiotic prescribing and it helped discussions with carers about concerns and treatment decisions. The intervention was popular but may need to be adapted to align more with clinicians’ consultation flow and remote consultations.

Findings of the feasibility study:

  1. Hay AD, Redmond NM, Turnbull S, Christensen H, Thornton H, Little P, Thompson     M, Delaney B, Lovering AM, Muir P, Leeming JP, Vipond B, Stuart B, Peters TJ,      Blair PS. Development and internal validation of a clinical rule to improve antibiotic     use in children presenting to primary care with acute respiratory tract infection and   cough: a prognostic cohort study. Lancet Respir Med. 2016 Nov;4(11):902-910.
  2. Blair PS, Turnbull S, Ingram J, Redmond N, Lucas PJ, Cabral C, Hollinghurst S, Dixon P, Peters T, Horwood J, Little P, Francis NA, Gilbertson A, Jameson C, Hay AD. Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough. BMJ Open. 2017 May 9;7(5):e014506.
  3. Seume P, Bevan S, Young G, Ingram J, Clement C, Cabral C, Lucas PJ, Beech E, Taylor J, Horwood J, Dixon P, Gulliford MC, Francis N, Creavin ST, Lane A, Hay AD, Blair PS. Protocol for an 'efficient design' cluster randomised controlled trial to evaluate a complex intervention to improve antibiotic prescribing for CHIldren presenting to primary care with acute COugh and respiratory tract infection: the CHICO study. BMJ Open. 2021 Mar 29;11(3):e041769.
  4. Blair PS, Ingram J, Clement C, Young G, Seume P, Taylor J, Cabral C, Lucas PJ, Beech E, Horwood J, Dixon P, Gulliford MC, Francis N, Creavin ST, Lane A, Bevan S, Hay AD. Can primary care research be conducted more efficiently using routinely reported practice-level data: a cluster randomised controlled trial conducted in England? BMJ Open. 2022 Jul 1;12(7):e061574
5. Clement C, Ingram J, Cabral C, Blair PS, Hay AD, Seume P, Horwood J. Implementation of CHIldren with acute COugh (CHICO) intervention to improve antibiotics management: qualitative study. Br J Gen Pract. 2024 Jan 31: BJGP.2023.0330. doi: 10.3399/BJGP.2023.0330
6. Blair PS, Young G, Clement C, Dixon P, Seume P, Ingram J, Taylor J, Cabral C, Lucas PJ, Beech E, Horwood J, Gulliford M, Francis NA, Creavin S, Lane JA, Bevan S, Hay AD. Multi-faceted intervention to improve management of antibiotics for children presenting to primary care with acute cough and respiratory tract infection (CHICO): efficient cluster randomised controlled trial. BMJ. 2023 Apr 26;381:e072488.
7. Blair PS, Young GJ, Clement C, Dixon P, Seume P, Ingram J, Taylor J, Horwood J, Lucas PJ, Cabral C, Francis NA, Beech E, Gulliford M, Creavin S, Lane JA, Bevan S, Hay AD. A multifaceted intervention to reduce antibiotic prescribing among CHIldren with acute COugh and respiratory tract infection: the CHICO cluster RCT. Health Technol Assess. 2023 Dec;27(32):1-110. [The HTA Chico Report]