A Randomized Trial of a Gamified Mobile App for Improving Antibiotic Adherence and Completion Rates in Children with Acute Respiratory Infections
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Background: Adherence to short-course antibiotic treatment in children depends largely on caregivers, and missed or irregular doses may reduce prescribed treatment exposure. Mobile applications combining reminders, tracking, and rewards may support medication administration. Objective: To evaluate a caregiver-operated gamified mobile application for improving antibiotic adherence and prescribed-dose completion among children with acute respiratory infections. Methods: This parallel-group randomized controlled trial enrolled 80 children aged 2–10 years receiving outpatient oral antibiotic treatment in Central Punjab, Pakistan. Participants were allocated equally to a gamified mobile-application intervention or standard care. Complete follow-up data were available for 75 participants. Primary outcomes were adherence score and percentage of prescribed doses recorded as administered; secondary outcomes included caregiver-reported symptom severity and recovery. Results: The intervention group had higher post-treatment adherence than controls (91.4 ± 6.8 vs 78.2 ± 9.5; mean difference 13.2, 95% CI 9.4–17.0; p<0.001) and greater recorded-dose completion (94.6 ± 5.2% vs 81.3 ± 8.7%; mean difference 13.3%, 95% CI 10.0–16.6%; p<0.001). Symptom reduction was greater in the intervention group (5.2 ± 1.3 vs 3.5 ± 1.4; p<0.001), while caregiver-reported recovery occurred in 81.1% and 57.9%, respectively. Conclusion: The multicomponent mobile intervention was associated with improved short-term recorded adherence and caregiver-reported outcomes, although complete-case analysis and subjective measurement limit interpretation
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