A point-of-care rule cut antibiotics in febrile infants without more harm, and IV fluids in severe malnutrition remain uncertain

The edition in brief

In an open cluster randomised trial across 25 European paediatric emergency departments, 4,882 children aged 6 days to 36 months with fever without source were managed with usual care or a decision rule based on age, symptoms, urinalysis and point-of-care procalcitonin. Antibiotic exposure within 15 days fell from 38.0% to 26.2% (OR 0.57, 95% CI 0.43 to 0.75) with similar morbidity and mortality (OR 0.83, 0.57 to 1.22). A meta-analysis of three trials (484 children) of intravenous versus oral rehydration in severe acute malnutrition with severe dehydration found in-hospital mortality RR 0.71 (95% CI 0.46 to 1.10) with moderate certainty, a range from a 54% reduction to a 10% increase, and less severe hyponatraemia with intravenous fluids (RR 0.66). A single-centre quality-improvement project in a paediatric emergency department raised the proportion of children with pneumonia or sinusitis receiving a guideline-recommended short antibiotic course from 13.1% to 64.8% with no change in return visits. A pilot trial of 32 teenagers found financial incentives did not significantly improve inhaler adherence (73% vs 56%, p = 0.077). The pearl covers weighing every child before prescribing.