Digital decision support tool reduces antibiotic prescription by more than 60%

In primary healthcare facilities in sub-Saharan Africa, providers often prescribe antibiotics as a precaution when they are uncertain about diagnoses due to limited time, overwhelming workloads, and a lack of access to simple diagnostic tests. This results in substantial overprescription of antibiotics, which accelerates the global threat of antimicrobial resistance. In Africa, antibiotic resistance already accounts for more deaths than malaria and HIV combined.

Digital tools can support healthcare providers, guiding them through clinical assessments and recommending appropriate treatments. As part of the DYNAMIC project, ePOCT+, a digital clinical decision support algorithm used on a tablet, was developed. The tool integrates simple tests, such as oxygen saturation and hemoglobin measurements and inflammation markers to assist primary care clinicians in managing acutely ill children aged 14 years and younger.

Antibiotic prescription rates dropped dramatically from 71% to 25%

To test ePOCT+, researchers conducted a large study in 32 health centres in rural Rwanda, including nearly 60,000 consultations with sick children. The study showed that antibiotic prescription dropped from 71% to 25% in health centers using ePOCT+ compared to those providing standard care, and children recovered at similar rates in both groups, demonstrating that fewer antibiotics did not compromise their outcomes. These results were published yesterday in PLOS Medicine. “This study demonstrates that a comprehensive digital tool combining clinical guidance with simple diagnostic tests and clinical mentorship can substantially reduce unnecessary antibiotic use in resource-limited primary care settings without harming children's recovery,” says Alexandra Kulinkina, project leader at Swiss TPH and first author of the publication.

The project was well received by the Ministry of Health. Reduced use of antibiotics in the study districts was also reflected in the national prescribing trends, according to analyses by the Rwanda Social Security Board, which finances the country’s public health insurance scheme. “This shows that the reductions seen in the study were also visible in routine health system data, indicating real-world impact beyond the trial setting,” says Kulinkina. In addition to the tablet-based application, the DYNAMIC team handed over the ePOCT+ algorithm to the Ministry of Health as a web-based module that could be integrated into the electronic health record solution targeted for implementation across all primary health facilities in Rwanda.

Similar results were found in a previous study in Tanzania, where antibiotic prescription fell from 71 to 23% without affecting cure rates. “Extending this approach to other countries could make a significant contribution to global efforts to curb antibiotic resistance while ensuring high-quality care for children,” says Kulinkina.

About the Dynamic Project

The study was part of the DYNAMIC project, that is led by Unisanté and Swiss TPH with partners from the Rwanda Biomedical Centre, the Ifakara Health Institute and the National Institute of Medical Research in Tanzania and funded by the Fondation Botnar and the Swiss Agency for Development and Cooperation. Swiss TPH led the design and implementation of the study in Rwanda.

Why it matters

Antimicrobial resistance is rising rapidly, driven in part by unnecessary antibiotic use in primary care. The findings show that integrated digital decision support can help frontline clinicians prescribe more appropriately without compromising child health. Scalable solutions such as ePOCT+ offer a practical pathway for health systems to strengthen quality of care while protecting the effectiveness of antibiotics for the future.

Contact for media requests: communications@swisstph.ch