دورية أكاديمية
أعرض في EDS

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

التفاصيل البيبلوغرافية
العنوان: Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings.
المؤلفون: Hopkins H; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Bruxvoort KJ; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Cairns ME; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Chandler CI; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Leurent B; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Ansah EK; Ghana Health Service, Accra, Ghana., Baiden F; Ensign College of Public Health, Kpong, Ghana., Baltzell KA; University of California, San Francisco, CA, USA., Björkman A; Karolinska Institutet, Stockholm, 17176, Sweden., Burchett HE; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Clarke SE; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., DiLiberto DD; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Elfving K; University of Gothenburg, Gothenburg, Sweden., Goodman C; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Hansen KS; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.; University of Copenhagen, Copenhagen, DK1014, Denmark., Kachur SP; US Centers for Disease Control and Prevention, Atlanta, GA, USA., Lal S; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Lalloo DG; Liverpool School of Tropical Medicine, Liverpool, UK., Leslie T; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.; Health Protection Research Organisation, Kabul, Afghanistan., Magnussen P; Centre for Medical Parasitology, University of Copenhagen and Copenhagen University Hospital, and Department for Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark., Jefferies LM; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Mårtensson A; Uppsala University, Uppsala, Sweden., Mayan I; Health Protection Research Organisation, Kabul, Afghanistan., Mbonye AK; Ministry of Health, Kampala, Uganda.; Makerere University School of Public Health, Kampala, Uganda., Msellem MI; Zanzibar Malaria Elimination Programme, Tanzania., Onwujekwe OE; Department of Pharmacology and Therapeutics, University of Nigeria, Enugu, Nigeria., Owusu-Agyei S; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.; Kintampo Health Research Centre, Kintampo, Ghana., Reyburn H; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Rowland MW; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Shakely D; Centre for Malaria Research, Karolinska Institutet, Stockholm, Sweden, and Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Vestergaard LS; Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark., Webster J; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Wiseman VL; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia., Yeung S; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Schellenberg D; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Staedke SG; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Whitty CJ; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
المصدر: BMJ (Clinical research ed.) [BMJ] 2017 Mar 29; Vol. 356, pp. j1054. Date of Electronic Publication: 2017 Mar 29.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: British Medical Association Country of Publication: England NLM ID: 8900488 Publication Model: Electronic Cited Medium: Internet ISSN: 1756-1833 (Electronic) Linking ISSN: 09598138 NLM ISO Abbreviation: BMJ Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : British Medical Association
مواضيع طبية MeSH: Observational Studies as Topic* , Randomized Controlled Trials as Topic* , Reagent Kits, Diagnostic*, Anti-Bacterial Agents/*administration & dosage , Malaria/*diagnosis , Malaria/*drug therapy , Practice Patterns, Physicians'/*statistics & numerical data, Africa/epidemiology ; Ambulatory Care ; Antimalarials/administration & dosage ; Antimalarials/therapeutic use ; Asia/epidemiology ; Diagnostic Tests, Routine ; Fever/blood ; Fever/diagnosis ; Fever/drug therapy ; Humans ; Malaria/blood ; Program Evaluation
مستخلص: 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.
(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.)
التعليقات: Comment in: BMJ. 2017 May 11;357:j2290. doi: 10.1136/bmj.j2290. (PMID: 28495670)
Erratum in: BMJ. 2017 Jun 29;357:j3168. doi: 10.1136/bmj.j3168. (PMID: 28663173)
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معلومات مُعتمدة: MR/K012126/1 United Kingdom MRC_ Medical Research Council; MR/N003810/1 United Kingdom MRC_ Medical Research Council
المشرفين على المادة: 0 (Anti-Bacterial Agents)
0 (Antimalarials)
0 (Reagent Kits, Diagnostic)
تواريخ الأحداث: Date Created: 20170331 Date Completed: 20170420 Latest Revision: 20240607
رمز التحديث: 20240607
مُعرف محوري في PubMed: PMC5370398
DOI: 10.1136/bmj.j1054
PMID: 28356302
قاعدة البيانات: MEDLINE
الوصف
تدمد:1756-1833
DOI:10.1136/bmj.j1054