Antibiotic prescribing practices for patients with fever in the transition from presumptive treatment of malaria to ‘confirm and treat’ in Zambia: a cross‐sectional study

Abstract

Abstractobjectives To evaluate antibiotic use among patients presenting to primary healthcare facilities with febrile illness in Zambia.methods We analysed data from a 2011 nationwide cross-sectional health facility survey of routine malaria case management in Zambia. Patient consultation observation and medical record charts were used to calculate the proportion of febrile patients who were prescribed antibiotics, stratified by symptoms, health workers' diagnosis and malaria test results. Logistic regression was used to identify factors affecting antibiotic prescribing behaviour. conclusions Testing positive for malaria or receiving a malaria diagnosis was associated with reduced antibiotic prescribing, while testing negative, not being tested or a diagnosis of URTI resulted in higher rates of antibiotic prescribing. There is a need for improving diagnostic capacity for nonmalaria causes of febrile illness at healthcare delivery points and limiting antibiotic use to patients with definite bacterial infections.

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

“…The potential for this prescribing shift was recognised in the early days of increasing the use of these tests, 16 and these concerns now seem to be real in many settings. 18 There is a widespread assumption that improving pathogen specific diagnosis with better tests will reduce overuse of antimicrobials, but it might simply shift overuse from one class to another.…”

“…Improvements in malaria diagnosis could simply reduce the overuse of antimalarials, or divert overuse to other products like antipyretics, or it could divert antimalarial overuse to other antimicrobials, particularly antibiotics. 18 Prescribing practices are not well documented or regulated in regions with little healthcare infrastructure and with relatively unrestricted access to antimicrobials. [18][19][20][21][22][23][24] Similarly, monitoring and surveillance of antimicrobial resistance is not conducted in most lower and middle income countries, but available data do show clinically relevant resistance in many common bacterial pathogens.…”

“…18 Prescribing practices are not well documented or regulated in regions with little healthcare infrastructure and with relatively unrestricted access to antimicrobials. [18][19][20][21][22][23][24] Similarly, monitoring and surveillance of antimicrobial resistance is not conducted in most lower and middle income countries, but available data do show clinically relevant resistance in many common bacterial pathogens. [25][26][27][28][29][30][31][32][33][34][35] The ACT Consortium (www.actconsortium.org) included several studies that evaluated the potential of rapid diagnostic tests for malaria to improve case management for patients with undifferentiated fever in malaria endemic areas.…”

Target Product Profile for a Diagnostic Assay to Differentiate between Bacterial and Non-Bacterial Infections and Reduce Antimicrobial Overuse in Resource-Limited Settings: An Expert Consensus

“…A recent study from South East Asia demonstrated that 38% of all febrile patients received an antimicrobial and that this was not focused on bacterial infections alone [2]. In Africa, the overuse of antibiotics seems to be even larger, with between 50% and 80% of febrile outpatients receiving antibiotics [39]. Test price estimates are based on expert opinion, and estimates of what is acceptable (<5 USD) or desirable (<1 USD) out-of-pocket costs in LMICs.…”

“…The overuse of antimicrobial drugs contributes to the global increase of antimicrobial resistance (AMR) and it is estimated that currently 500,000 people die annually from infections caused by drug resistant pathogens [12,13]. In low and middle income countries (LMICs), antimicrobial overuse is probably greater, given the paucity of diagnostic tests, fewer controls on antimicrobial dispensing, and a lack of antimicrobial stewardship programs [2,11,14] which likely contributes to an antibiotic resistance problem of alarming magnitude [15,16]. The importance of diagnostic tests for evidence-based treatment has been recognized by the World Health Organization (WHO) and other global health stakeholders as a direct means of reducing the inappropriate use of antimicrobials and decreasing selective pressure on microbes toward drug resistance [17].…”