• Ruben Burvenich, David Ag Bos, Lien Lowie, Kiyano Peeters, Jaan Toelen, Laure Wynants, and Jan Y Verbakel.
• Leuven Unit for Health Technology Assessment Research (LUHTAR), Department of Public Health and Primary Care, KU Leuven; Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
• Br J Gen Pract. 2025 Feb 1; 75 (751): e90e97e90-e97.

BackgroundSafety-netting advice (SNA) can help in the management of acutely ill children.AimTo assess the effectiveness of different SNA methods on antibiotic prescription and consumption in acutely ill children.Design And SettingSystematic review and network meta-analysis of randomised controlled trials, cluster randomised trials, non-randomised studies of interventions, and controlled before-after studies in ambulatory care in high-income countries.MethodMEDLINE, Embase, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials were searched (22 January 2024). Risk of bias (RoB) was assessed with Cochrane's RoB 2 tool, the Revised Cochrane Tool for Cluster-Randomised Trials, and the Risk Of Bias In Non-randomised Studies - of Interventions tool. Certainty of evidence was assessed using the Confidence in Network Meta-Analysis approach. Sensitivity analyses and network meta-regression were performed.ResultsIn total, 30 studies (20 interventions) were included. Compared with usual care, paper SNA may reduce: antibiotic prescribing (odds ratio [OR] 0.66, 95% confidence interval [CI] = 0.53 to 0.82, I 2 = 92%, very low certainty, three studies, 35 988 participants), especially when combined with oral SNA (OR 0.40, 95% CI = 0.08 to 2.00, P-score = 0.86); antibiotic consumption (OR 0.39, 95% CI = 0.27 to 0.58, low RoB, one study, 509 participants); and return visits (OR 0.74, 95% CI = 0.63 to 0.87). Compared with usual care, video SNA, read-only websites, oral SNA, and web-based SNA (in descending order of effectiveness) may increase parental knowledge (ORs 2.33-4.52), while paper SNA may not (ORs 1.18-1.62). Similarly, compared with usual care, video SNA and web-based modules may improve parental satisfaction (ORs 1.94-4.08), while paper SNA may not (OR 1.85, 95% CI = 0.48 to 7.08).ConclusionPaper SNA (with oral SNA) may reduce antibiotic use and return visits. Video, oral, and online SNA may improve parental knowledge, whereas video SNA and web-based modules may increase parental satisfaction.© The Authors.

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