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Improved paediatric antimicrobial prescribing with a smartphone application: a before and after interventional study
  1. Sarah Primhak1,2,
  2. Natasha Pool3,4,
  3. Michelle Shien Yee Sam1,
  4. Eamon Duffy5,
  5. Stephen R Ritchie2,6,
  6. Rachel Webb1,2,4,
  7. Elizabeth Wilson1,
  8. Lesley Voss1,
  9. Emma J Best1,2
  1. 1 Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand
  2. 2 Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  3. 3 Antimicrobial Stewardship Pharmacist, Starship Children's Health, Auckland, New Zealand
  4. 4 Paediatrics, Middlemore Hospital, Auckland, New Zealand
  5. 5 Antimicrobial Stewardship Pharmacist, Auckland City Hospital, Auckland, New Zealand
  6. 6 Infectious Diseases, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to Dr Sarah Primhak, Paediatric Infectious Diseases, Starship Children's Health, Auckland 1023, New Zealand; sprimhak{at}


Introduction Children have a high consumption of antimicrobials that require complicated decision-making by prescribers. Despite this, antimicrobial stewardship (AMS) interventions are often not translated into paediatric medicine. Script is a smartphone application (app) launched in Auckland, New Zealand to support decision-making for antimicrobial prescribers. The aim was to improve adherence to existing local clinical guidelines for both adult and paediatric infections.

Methods Inpatient and emergency department antimicrobial prescriptions were prospectively collected and evaluated for guideline adherence. Baseline prescribing data were collected and compared with prescribing at 4 months and 1 year after the app was launched. Prescriptions were graded as ‘appropriate’ or ‘inappropriate’ by investigators. Grading was done blinded to timing of the prescription relative to the intervention.

Results Following the launch of the Script app, guideline adherence significantly increased from 241 of 348 (69%) antimicrobial prescriptions graded as appropriate during the baseline period to 301 of 359 (83%) after 4 months (p<0.0001). This improvement from baseline was sustained at 1 year with 263 of 323 (81%) adherence (p<0.001). At 1 year, this improvement could be demonstrated separately for medical, surgical and emergency department prescriptions.

Conclusion There was a significant and sustained improvement in adherence to paediatric antimicrobial guidelines following the introduction of a prescribing support app. The need to seek guidance for antimicrobial doses due to the age-based and weight-based calculations in paediatrics may mean that AMS interventions such as decision support and prescribing tools are particularly well suited to paediatric prescribing.

  • Child Health
  • Infectious Disease Medicine
  • Information Technology
  • Paediatrics

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  • Contributors The authors confirm contribution to the paper as follows: study conception and design—SP, NP, ED, SRR, EW, LV, EJB and RW; data collection—SP, NP and MSYS; analysis and interpretation of results—SP; draft manuscript preparation—SP, NP, EW, EJB, LV, RW, MSYS, ED and SRR. Guarantor—SP. All authors reviewed the results and approved the final version of the manuscript.

  • Funding This work was supported by Mercury Energy through the Starship Foundation (grant number SF1571) and the Joan Mary Reynolds Charitable Trust Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.