Reducing antibiotic use for acute, uncomplicated upper respiratory tract infections in children by eHealth applications that support adequate fever management and safe use of effective natural medicinal products

This dissertation examines how integrative, digital strategies may reduce antibiotic (AB) use for Dutch children with acute, uncomplicated upper respiratory tract infections (URTIs). A phase-specific fever management tool (FeverApp) and a digital decision aid for natural medicinal products (NMP WebApp) were studied.
Survey research (n=414) found parents and primary care professionals were positive about the use of NMPs for pediatric URTIs. A systematic mechanistic review of four promising NMPs suggested immunomodulatory, antiviral, and antibacterial effects for URTIs, though the evidence was limited and largely adult-based.
An exploratory literature review indicated that supportive fever management may aid recovery. However, this was not yet studied in uncomplicated infections or in children. Nevertheless, a survey (n=343) showed broad support for this approach among parents and primary care professionals. Also, most respondents believed that both apps could help reduce antibiotic use and healthcare visits.
Outcomes of usability testing of the FeverApp (n=20) and an NMP WebApp (n=14) were positive, with minor suggestions for refinement.
Finally, a prospective, population-based pilot study (n=52) demonstrated feasibility of a developed RCT-protocol and suggested fever during self-limiting infections may cause beneficial within-individual shifts in gut microbiota, though results were exploratory and not significant at group level.
In sum, applied safely and responsibly, the investigated apps may strengthen self-management and shared decision-making, support rational AB prescribing, reduce healthcare visits, and promote long-term microbial health. This thesis argues for a cautious shift from symptom control toward supporting physiological processes in acute, uncomplicated infections, while underscoring the need for larger follow-up studies.