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  • Hopkins, H.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)

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

  • Article/chapterEnglish2017

Publisher, publication year, extent ...

  • 2017-03-29
  • BMJ,2017

Numbers

  • LIBRIS-ID:oai:gup.ub.gu.se/252733
  • https://gup.ub.gu.se/publication/252733URI
  • https://doi.org/10.1136/bmj.j1054DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:135472676URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-320035URI

Supplementary language notes

  • Language:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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. Analysis of nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. 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. 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. 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.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Bruxvoort, K. J.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Cairns, M. E.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Chandler, C. I. R.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Leurent, B.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Elfving, KristinaGothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics(Swepub:gu)xelfkr (author)
  • Baiden, F.Ensign Coll Publ Hlth, Kpong, Ghana. (author)
  • Baltzell, K. A.Univ Calif San Francisco, San Francisco, CA 94143 USA. (author)
  • Bjorkman, A.Karolinska Institutet,Karolinska Inst, S-17176 Stockholm, Sweden. (author)
  • Burchett, H. E. D.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Clarke, S. E.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • DiLiberto, D. D. (author)
  • Elfving, KristinaGothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics(Swepub:gu)xelfkr (author)
  • Goodman, C.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Hansen, K. S.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England.;Univ Copenhagen, DK-1014 Copenhagen, Denmark. (author)
  • Kachur, S. P.US Ctr Dis Control & Prevent, Atlanta, GA USA. (author)
  • Lal, S.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Lalloo, D. G.Univ Liverpool Liverpool Sch Trop Med, Liverpool, Merseyside, England. (author)
  • Leslie, T.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England.;Hlth Protect Res Org, Kabul, Afghanistan. (author)
  • Magnussen, P.Univ Copenhagen, Ctr Med Parasitol, Copenhagen, Denmark.;Univ Copenhagen, Copenhagen Univ Hosp, Copenhagen, Denmark.;Univ Copenhagen, Dept Vet Dis Biol, Copenhagen, Denmark. (author)
  • Jefferies, L. M.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Mårtensson, Andreas,1963-Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH)(Swepub:uu)andma331 (author)
  • Mayan, I.Hlth Protect Res Org, Kabul, Afghanistan. (author)
  • Mbonye, A. K.Minist Hlth, Kampala, Uganda.;Makerere Univ, Sch Publ Hlth, Kampala, Uganda. (author)
  • Msellem, M. I.Zanzibar Malaria Eliminat Programme, Zanzibar, Tanzania. (author)
  • Onwujekwe, O. E.Univ Nigeria, Dept Pharmacol & Therapeut, Enugu, Nigeria. (author)
  • Owusu-Agyei, S.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England.;Kintampo Hlth Res Ctr, Kintampo, Ghana. (author)
  • Reyburn, H.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Rowland, M. W.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Shakely, D.Karolinska Inst, Ctr Malaria Res, Stockholm, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Hlth Metr, Gothenburg, Sweden. (author)
  • Vestergaard, L. S.Statens Serum Inst, Dept Infect Dis Epidemiol, Copenhagen, Denmark. (author)
  • Webster, J.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Wiseman, V. L.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England.;Univ New South Wales, Sch Publ Hlth & Community Med, Sydney, NSW, Australia. (author)
  • Yeung, S.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Schellenberg, D.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Staedke, S. G.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Whitty, C. J. M.Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England. (author)
  • Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England.Institutionen för kliniska vetenskaper, Avdelningen för pediatrik (creator_code:org_t)

Related titles

  • In:Bmj-British Medical Journal: BMJ3561756-18330959-8138
  • In:BMJ: BMJ3560959-8138

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