van de Maat JS, Peeters D, Nieboer D, et al. - In children under 5 years, researchers intend to safely decrease antibiotic prescriptions with suspected lower RTI at the emergency department (ED), by implementing a clinical decision rule. Researchers designed a stepped-wedge cluster-randomized trial, including children aged 1–60 months presenting with fever and cough or dyspnoea to 8 EDs in The Netherlands. A validated clinical prediction model (Feverkidstool) including clinical characteristics and C-reactive protein was performed as a decision rule guiding antibiotic prescription during the intervention phase. They found that a clinical decision rule for childhood pneumonia did not decrease overall antibiotic prescription, but that it was non-inferior to usual care in this multicentre ED study. In this exploratory analysis, the results displayed fewer strategy failures and that fewer antibiotics were prescribed in low/intermediate-risk children, implying increased targeting of antibiotics by the decision rule.