Plain English Summary
Background and study aims
Over-prescribing antibiotics is a serious issue globally. It is also very common among children with acute upper respiratory tract infections. It has left many children suffering from bacterial resistance due to irrational use of antibiotics, especially in less developed rural areas. Antibiotics are widely abused in China, especially in rural areas. However, few studies have focused on this area in developing countries including China. We aim to carry out a study in rural Guangxi, China to test an effective approach of reducing over-prescribing antibiotics for upper respiratory infections (URTIs) among children.
Who can participate?
Parents/caregivers and doctors who have been taking care of children between 2-14 years old.
What does the study involve?
The 25 participating township hospitals in two counties of Guangxi province, China, will be randomly allocated into one of two groups. The hospitals in the control group will continue usual management according to the current national guidelines. The hospitals in the intervention group will receive an educational intervention for both clinicians and parents. Clinicians will receive antibiotic use guidelines, training on antibiotic use, monthly social media message reminders, an antibiotics use appraisal in the monthly hospital staff meeting, and specific short messages to be given to patient caregivers during clinical consultations. Parents will receive printed educational material describing rational antibiotic use, and videos about rational antibiotic use will play in the education area at the hospitals. A questionnaire survey will be conducted to see the changes in clinicians and caregivers' knowledge, attitude and practice before and after the intervention in each group. Interviews and group discussions will be used to see if this study is feasible and acceptable with the intervention package. We will assess effectiveness through the difference in the antibiotic prescription rate before and after the intervention and between the intervention and control groups.
What are the possible benefits and risks of participating?
This study may help to reduce irrational antibiotic use among clinician, increase knowledge on antibiotic use among rural caregivers/parents, improve the management of antibiotic use for policy makers, and change prescription behaviours of health providers. We do not expect there to be any risks for participants.
Where is the study run from?
China Global Health Research and Development, as the leading centre, is in collaboration with Guangxi Provincial Center for Disease Control, the University of Leeds, the Chinese University of Hong Kong and Shandong University.
When is the study starting and how long is it expected to run for?
From June 2015 to March 2016.
Who is funding the study?
China Programme, COMDIS Health Services Delivery Research Consortium
Who is the main contact?
Professor Xiaolin wie
Prof Xiaolin Wei
School of Public Health and Primary Care
Prince of Wales Hospital
Educational interventions on reducing antibiotic over-prescribing among children with upper respiratory infections (URIs) and acute bronchitis :a clustered randomized controlled trial in rural Guangxi, China
Educational interventions on both clinicians and parents are effective on reducing over-prescribing antibiotics for childhood upper respiratory infections (URIs) and acute bronchitis
Ethics Committee of Guangxi Provincial Centre for Disease Control and Prevention, 13/09/2014, ref: GXIRB2014-0036
Cluster randomized controlled trial
Primary study design
Secondary study design
Cluster randomised trial
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet
Upper respiratory infections (URIs) and acute bronchitis among children, which includes: acute URIs, common cold, acute tonsillitis and acute pharyngitis
The township hospitals randomly allocated into the intervention group will receive the educational intervention for both clinicians and parents.
1. Operational guidelines (based on Chinese antibiotic use guidelines, IMCI, and the NICE guideline, we will focus on but not limit to URIs)
2. Systematic training for clinicians in township hospitals on rational antibiotic use
3. Antibiotic prescription rate (APR) reminder - social media message reminders once a month by pharmacist
4. Antibiotics use appraisal in the monthly hospital staff meeting
5. Health education to patient caregivers: specific short messages to be given during clinical consultations
1. Printed educational material describing rational antibiotic use for childhood URIs
2. Videos to play in the education area at township hospitals, describing rational antibiotic use for childhood URIs
The control group will continue usual management according to the current national guidelines. Treatment is provided according to existing knowledge and antibiotics are given at the individual clinician’s discretion, while no systematic health education is provided.
Primary outcome measures
Antibiotics prescription rate (APR) of outpatient childhood URIs between 2-14 years old, measured at baseline (3 months prior to the intervention), 3 months after the intervention and 6 months after the intervention
Secondary outcome measures
Measured at baseline (3 months prior to the intervention), 3 months after the intervention and 6 months after the intervention:
1. Two and more than two antibiotic combination prescription rate
2. Broad-spectrum antibiotic use rate of outpatient prescriptions
3. Quinolones use rate
4. Average cost of a prescription
5. Antibiotics prescription rate of inpatient childhood URIs
6. Appropriateness of antibiotics use among inpatient childhood URIs
Overall trial start date
Overall trial end date
Participant inclusion criteria
All eligible township hospitals from the two selected counties of Guangxi who agree to participate in the study will be included. The two counties should have implemented the Essential Medicine List and Zero-markup policy in 2012.
1. Township hospitals: 25 township hospitals in two selected counties
2. Parents/caregivers: who have been taking care of children between 2 and 14 years old
3. Doctors: pedestrian or internal medicine clinician who is seeing children between 2 and 14 years old
1. Parents/caregivers: 6-8 parents/caregivers in each focus group discussion
2. Doctors: 1 township hospital director and 2 clinicians in each township
3. Prescriptions: outpatients: 40/township (before and after intervention), inpatients: 200/township (before and after intervention)
Target number of participants
25 clusters, each cluster requires at least 200 prescriptions
Participant exclusion criteria
1. Prescriptions for children diagnosed with diseases such as tuberculosis, HIV/AIDS or other immunodeficiency disease, any form of cancer, dyslipidaemia, chronic heart diseases, and pneumonia, who need long-term antibiotic treatment or prophylaxis
2. Children ≤2 years old and >14 years old will be excluded
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
25 township hospitals
Rong county and Liujiang
COMDIS Health Services Delivery Research Consortium
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
To be confirmed at a later date
Intention to publish date
Participant level data
Available on request
Results - basic reporting
2016 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/27235297