RT Journal Article SR Electronic T1 Optimising the management of childhood acute diarrhoeal disease using a rapid test-and- treat strategy and/or Lactobacillus reuteri DSM 17938: a multicentre, randomised, controlled, factorial trial in Botswana JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e007826 DO 10.1136/bmjgh-2021-007826 VO 7 IS 4 A1 Jeffrey M Pernica A1 Tonya Arscott-Mills A1 Andrew P Steenhoff A1 Margaret Mokomane A1 Banno Moorad A1 Mbabi Bapabi A1 Kwana Lechiile A1 Oarabile Mangwegape A1 Boswa Batisani A1 Norah Mawoko A1 Charles Muthoga A1 Thuvaraha Vanniyasingam A1 Joycelyne Ewusie A1 Amy Lowe A1 Janice M Bonsu A1 Alemayehu M Gezmu A1 Marek Smieja A1 Loeto Mazhani A1 Ketil Stordal A1 Lehana Thabane A1 Matthew S Kelly A1 David M Goldfarb YR 2022 UL http://gh.bmj.com/content/7/4/e007826.abstract AB Introduction The study aim was to determine if rapid enteric diagnostics followed by the provision of targeted antibiotic therapy (‘test-and-treat’) and/or Lactobacillus reuteri DSM 17938 would improve outcomes in children hospitalised in Botswana with acute gastroenteritis.Methods This was a multicentre, randomised, factorial, controlled, trial. Children aged 2–60 months admitted for acute non-bloody diarrhoea to four hospitals in southern Botswana were eligible. Participants were assigned to treatment groups by web-based block randomisation. Test-and-treat results were not blinded, but participants and research staff were blinded to L. reuteri/placebo assignment; this was dosed as 1×108 cfu/mL by mouth daily and continued for 60 days. The primary outcome was 60-day age-standardised height (HAZ) adjusted for baseline HAZ. All analyses were by intention to treat. The trial was registered at Clinicaltrials.gov.Results Recruitment began on 12 June 2016 and continued until 24 October 2018. There were 66 participants randomised to the test-and-treat plus L. reuteri group, 68 randomised to the test-and-treat plus placebo group, 69 to the standard care plus L. reuteri group and 69 to the standard care plus placebo group. There was no demonstrable impact of the test-and-treat intervention (mean increase of 0.01 SD, 95% CI −0.14 to 0.16 SD) or the L. reuteri intervention (mean decrease of 0.07 SD, 95% CI −0.22 to 0.08 SD) on adjusted HAZ at 60 days.Conclusions In children hospitalised for acute gastroenteritis in Botswana, neither a test-and-treat algorithm targeting enteropathogens, nor a 60-day course of L. reuteri DSM 17938, were found to markedly impact linear growth or other important outcomes. We cannot exclude the possibility that test-and-treat will improve the care of children with significant enteropathogens (such as Shigella) in their stool.Trial registration number NCT02803827.Data are available on reasonable request. Individual participant data that underlie the results reported in this article, after deidentification, will be made available, 12 months after publication until 36 months postpublication, to researchers whose proposed use of the data has been approved by an independent review committee. The study protocol has been attached. Requests for data sharing can be directed to the primary author.