PubTransformer

A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings.

Abstract Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia.Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study).Setting Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda.Participants 522 480 children and adults with acute febrile illness.Interventions Rapid diagnostic tests for malaria.Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings.Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole.Conclusions Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive up untargeted use of antibiotics. That 69% of patients were prescribed antibiotics when test results were negative probably represents overprescription.This included antibiotics from several classes, including those like metronidazole that are seldom appropriate for febrile illness, across varied clinical, health system, and epidemiological settings. It is often assumed that better disease specific diagnostics will reduce antimicrobial overuse, but they might simply shift it from one antimicrobial class to another. Current global implementation of malaria testing might increase untargeted antibiotic use and must be examined.
PMID
Related Publications

The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial.

Rapid diagnostic tests to improve treatment of malaria and other febrile illnesses: patient randomised effectiveness trial in primary care clinics in Afghanistan.

Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings.

Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial.

Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: a randomised controlled trial in Ghana.

Authors

Mayor MeshTerms
Keywords
Journal Title bmj (clinical research ed.)
Publication Year Start




PMID- 28356302
OWN - NLM
STAT- In-Process
DA  - 20170330
LR  - 20170413
IS  - 1756-1833 (Electronic)
IS  - 0959-535X (Linking)
VI  - 356
DP  - 2017 Mar 29
TI  - Impact of introduction of rapid diagnostic tests for malaria on antibiotic
      prescribing: analysis of observational and randomised studies in public and
      private healthcare settings.
PG  - j1054
LID - 10.1136/bmj.j1054 [doi]
AB  - Objectives To examine the impact of use of rapid diagnostic tests for malaria on 
      prescribing of antimicrobials, specifically antibiotics, for acute febrile
      illness in Africa and Asia.Design Analysisof nine preselected linked and
      codesigned observational and randomised studies (eight cluster or individually
      randomised trials and one observational study).Setting Public and private
      healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania,
      and Uganda.Participants 522 480 children and adults with acute febrile
      illness.Interventions Rapid diagnostic tests for malaria.Main outcome measures
      Proportions of patients for whom an antibiotic was prescribed in trial groups who
      had undergone rapid diagnostic testing compared with controls and in patients
      with negative test results compared with patients with positive results. A
      secondary aim compared classes of antibiotics prescribed in different
      settings.Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in
      control groups and 167 714/283 683 (59%) patients in intervention groups.
      Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive
      test result for malaria and to 69% (39 400/57 080) of those with a negative
      result. All but one study showed a trend toward more antibiotic prescribing in
      groups who underwent rapid diagnostic tests. Random effects meta-analysis of the 
      trials showed that the overall risk of antibiotic prescription was 21% higher
      (95% confidence interval 7% to 36%) in intervention settings. In most
      intervention settings, patients with negative test results received more
      antibiotic prescriptions than patients with positive results for all the most
      commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one
      exception), tetracyclines, and metronidazole.Conclusions Introduction of rapid
      diagnostic tests for malaria to reduce unnecessary use of antimalarials-a
      beneficial public health outcome-could drive up untargeted use of antibiotics.
      That 69% of patients were prescribed antibiotics when test results were negative 
      probably represents overprescription.This included antibiotics from several
      classes, including those like metronidazole that are seldom appropriate for
      febrile illness, across varied clinical, health system, and epidemiological
      settings. It is often assumed that better disease specific diagnostics will
      reduce antimicrobial overuse, but they might simply shift it from one
      antimicrobial class to another. Current global implementation of malaria testing 
      might increase untargeted antibiotic use and must be examined.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Hopkins, Heidi
AU  - Hopkins H
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Bruxvoort, Katia J
AU  - Bruxvoort KJ
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Cairns, Matthew E
AU  - Cairns ME
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Chandler, Clare I R
AU  - Chandler CI
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Leurent, Baptiste
AU  - Leurent B
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Ansah, Evelyn K
AU  - Ansah EK
AD  - Ghana Health Service, Accra, Ghana.
FAU - Baiden, Frank
AU  - Baiden F
AD  - Ensign College of Public Health, Kpong, Ghana.
FAU - Baltzell, Kimberly A
AU  - Baltzell KA
AD  - University of California, San Francisco, CA, USA.
FAU - Bjorkman, Anders
AU  - Bjorkman A
AD  - Karolinska Institutet, Stockholm, 17176, Sweden.
FAU - Burchett, Helen E D
AU  - Burchett HE
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Clarke, Sian E
AU  - Clarke SE
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - DiLiberto, Deborah D
AU  - DiLiberto DD
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Elfving, Kristina
AU  - Elfving K
AD  - University of Gothenburg, Gothenburg, Sweden.
FAU - Goodman, Catherine
AU  - Goodman C
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Hansen, Kristian S
AU  - Hansen KS
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
AD  - University of Copenhagen, Copenhagen, DK1014, Denmark.
FAU - Kachur, S Patrick
AU  - Kachur SP
AD  - US Centers for Disease Control and Prevention, Atlanta, GA, USA.
FAU - Lal, Sham
AU  - Lal S
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Lalloo, David G
AU  - Lalloo DG
AD  - Liverpool School of Tropical Medicine, Liverpool, UK.
FAU - Leslie, Toby
AU  - Leslie T
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
AD  - Health Protection Research Organisation, Kabul, Afghanistan.
FAU - Magnussen, Pascal
AU  - Magnussen P
AD  - Centre for Medical Parasitology, University of Copenhagen and Copenhagen
      University Hospital, and Department for Veterinary Disease Biology, University of
      Copenhagen, Copenhagen, Denmark.
FAU - Jefferies, Lindsay Mangham
AU  - Jefferies LM
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Martensson, Andreas
AU  - Martensson A
AD  - Uppsala University, Uppsala, Sweden.
FAU - Mayan, Ismail
AU  - Mayan I
AD  - Health Protection Research Organisation, Kabul, Afghanistan.
FAU - Mbonye, Anthony K
AU  - Mbonye AK
AD  - Ministry of Health, Kampala, Uganda.
AD  - Makerere University School of Public Health, Kampala, Uganda.
FAU - Msellem, Mwinyi I
AU  - Msellem MI
AD  - Zanzibar Malaria Elimination Programme, Tanzania.
FAU - Onwujekwe, Obinna E
AU  - Onwujekwe OE
AD  - Department of Pharmacology and Therapeutics, University of Nigeria, Enugu,
      Nigeria.
FAU - Owusu-Agyei, Seth
AU  - Owusu-Agyei S
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
AD  - Kintampo Health Research Centre, Kintampo, Ghana.
FAU - Reyburn, Hugh
AU  - Reyburn H
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Rowland, Mark W
AU  - Rowland MW
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Shakely, Deler
AU  - Shakely D
AD  - Centre for Malaria Research, Karolinska Institutet, Stockholm, Sweden, and Health
      Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
FAU - Vestergaard, Lasse S
AU  - Vestergaard LS
AD  - Department of Infectious Disease Epidemiology, Statens Serum Institut,
      Copenhagen, Denmark.
FAU - Webster, Jayne
AU  - Webster J
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Wiseman, Virginia L
AU  - Wiseman VL
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
AD  - School of Public Health and Community Medicine, University of New South Wales,
      Sydney, Australia.
FAU - Yeung, Shunmay
AU  - Yeung S
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Schellenberg, David
AU  - Schellenberg D
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Staedke, Sarah G
AU  - Staedke SG
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
FAU - Whitty, Christopher J M
AU  - Whitty CJ
AD  - London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
LA  - eng
PT  - Journal Article
DEP - 20170329
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
PMC - PMC5370398
EDAT- 2017/03/31 06:00
MHDA- 2017/03/31 06:00
CRDT- 2017/03/31 06:00
PST - epublish
SO  - BMJ. 2017 Mar 29;356:j1054. doi: 10.1136/bmj.j1054.

<?xml version="1.0" encoding="UTF-8"?>
<b:Sources SelectedStyle="" xmlns:b="http://schemas.openxmlformats.org/officeDocument/2006/bibliography"  xmlns="http://schemas.openxmlformats.org/officeDocument/2006/bibliography" >
</b:Sources>