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A Smartphone Antimicrobial Prescribing App Did Not Outperform Paper Guidelines Across Six Lao Hospitals

Across a stepped-wedge cluster randomized trial in six Lao hospitals, a smartphone version of national antimicrobial prescribing guidelines plus one stewardship training session did not significantly improve adherence over paper versions after adjustment for time, clustering, and confounders. Inpatient adherence was 25.6% versus 17.0% before adjustment, but the adjusted odds ratio was 1.26 (95% CI 0.8–1.9; p=0.276); outpatient results were also null. The finding argues for sustained, multifaceted stewardship rather than guideline access alone.