Impact of Dengue Rapid Diagnostic Tests on the Prescription of Antibiotics and Anti-Inflammatory Drugs by Physicians in an Endemic Area in Colombia

Tello-Cajiao, María Elena; Osório, Lyda

doi:10.4269/ajtmh.19-0222

Cited by 7 publications

(5 citation statements)

References 28 publications

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“…Notably, in both settings, antibiotic prescription decreased to less than half after dengue was confirmed; this finding indicated that the non-specific symptoms or signs of dengue plays a significant role in physicians’ decisions to prescribe antibiotics. Our findings are consistent with previous studies in adults with dengue or acute febrile illnesses, demonstrating that a positive dengue test result can significantly reduce a patient’s likelihood of inappropriately receiving antibiotics in either the outpatient or inpatient setting [ 20 , 21 ].…”

Section: Discussionsupporting

confidence: 92%

Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers?

Shen,

Lien,

Chou

et al. 2024

International Journal for Quality in Health Care

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Inappropriate antibiotic use contributes to antimicrobial resistance, a global public health threat. The non-specific manifestations of dengue, itself a growing public health threat, lead to avoidable empiric antibiotic prescription, particularly in children. In this national pooled population-based cross-sectional study, we evaluated child and physician characteristics associated with antibiotics prescription in confirmed dengue cases in Taiwan. Linking national health care insurance claims and reports of confirmed dengue cases from 2008 to 2015, there were 7086 children with confirmed dengue with 21 744 outpatient visits and 2520 inpatient admissions. We assessed the presence of antibiotic prescription in outpatient and inpatient settings separately a week before or after the confirmation date. Logistic regression models with generalized estimating equations were applied to identify patient, practitioner, and other factors associated with antibiotic prescription. A total of 29.4% of children <18 years old with dengue who did not have a concomitant bacterial infection were prescribed antibiotics during the 14-day assessment period. Antibiotics prescription was reduced from 13.5% to 6.3% and from 43.2% to 19.3% in outpatient and inpatient settings, respectively, after dengue was confirmed. Young children were more likely to receive antibiotics. Significant variations in antibiotic prescribing across physicians were observed only in outpatient settings: physicians ≥60 years old and physicians practicing at clinics and in non-urban facilities were more likely to prescribe antibiotics. Antibiotics were less likely to be prescribed during an exceptional 2-year epidemic than in other years. Antibiotic prescribing for dengue, an arboviral infection affecting half of the global population, was shown to occur in 29% of paediatric cases in Taiwan. That potentially avoidable antibiotic consumption could be reduced by improving antibiotic stewardship, informed by understanding the conditions under which antibiotics are prescribed and the availability of prevention strategies for viral diseases, including dengue. We identified a number of such factors in this national population-based study.

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Section: Discussionsupporting

confidence: 92%

Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers?

Shen,

Lien,

Chou

et al. 2024

International Journal for Quality in Health Care

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“…While antibiotics may be prescribed inappropriately for conditions that are likely to have a viral etiology, they also may be used in early intervention of febrile illnesses when the pre-test probability of a bacterial infection argues for empirical therapy. The non-specific clinical manifestations of dengue (DENV) overlap with signs and symptoms of other febrile illnesses common to tropical and subtropical zones, such as leptospirosis, for which antimicrobial therapy is therapeutic [ 2 – 7 ]. At the point of clinical presentation, differentiating dengue from bacterial infections that should be treated with antibiotics may be difficult but also is contextual, depending on the local epidemiology of the respective pathogens [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…At the point of clinical presentation, differentiating dengue from bacterial infections that should be treated with antibiotics may be difficult but also is contextual, depending on the local epidemiology of the respective pathogens [ 8 ]. For example, within Thailand, the likelihood of encountering dengue versus leptospirosis differs geographically and pre-test strategies for empirical use of antibiotics in respective locations have been modeled [ 7 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Population-based assessment of factors influencing antibiotic prescribing for adults with dengue infection in Taiwan

et al. 2022

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Background Antibiotic treatment for dengue is likely considerable and potentially avoidable but has not been well characterized. This study aimed to assess antibiotic prescribing for confirmed dengue cases in outpatient and inpatient settings and to identify associated patient, physician and contextual factors. Methods 57,301 adult dengue cases reported in Taiwan between 2008–2015 were analyzed. We assessed both outpatient and inpatient claims data of dengue patients from a week before to a week after their dengue infections were confirmed under Taiwan’s National Health Insurance program. A multivariable logistic regression with generalized estimating equations was used to estimate the probability of antibiotic prescribing in dengue patients. Results Overall, 24.6% of dengue patients were prescribed an antibiotic during the 14 day-assessment period. Antibiotics were prescribed in 6.1% and 30.1% of outpatient visits and inpatient admissions, respectively. Antibiotic prescriptions were reduced by ~50% in epidemic years. Among inpatients, advanced age, females, and major comorbidities were risk factors for receipt of an antibiotic; antibiotics were used in 26.0% of inpatients after dengue was diagnosed. Significant differences in antibiotic prescribing practices were observed among physicians in outpatient settings but not in inpatient settings. Conclusions In addition to patient and physician demographic characteristics, contextual factors such as care setting and during epidemics significantly influenced prescription of antibiotics. Characterization of prescribing patterns should help direct programs to curb antibiotic prescribing.

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“…Together, these different factors may not only help in understanding the rising incidence and prevalence rates in our country but also explain the increasingly frequent severe and fatal cases [30] Unfortunately, most of the reported dengue cases in Colombia are diagnosed by clinical criteria, and only a small percentage of the cases are confirmed by Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) test or reverse transcriptionpolymerase chain reaction (RT-PCR) (34.7%); only severe or fatal cases are investigated by non-structural protein-1 (NS1) ELISA or RT-PCR [44,45]. For these reasons, some secondary and tertiary care hospitals independently perform rapid diagnostic tests (RDT) for IgM/IgG or NS1 to improve the clinical diagnosis and treatment of cases suspected of dengue [46][47][48]. Despite the widespread use of RDT in Colombia, the few reports evaluating the performance of RDT suggest that a negative result in these tests does not rule out dengue; therefore, clinicians should be aware of dengue diagnosis and confirm cases by laboratory tests [47][48][49][50].…”

Section: Introductionmentioning

confidence: 99%

“…For these reasons, some secondary and tertiary care hospitals independently perform rapid diagnostic tests (RDT) for IgM/IgG or NS1 to improve the clinical diagnosis and treatment of cases suspected of dengue [46][47][48]. Despite the widespread use of RDT in Colombia, the few reports evaluating the performance of RDT suggest that a negative result in these tests does not rule out dengue; therefore, clinicians should be aware of dengue diagnosis and confirm cases by laboratory tests [47][48][49][50].…”

Section: Introductionmentioning

confidence: 99%

Improving dengue case confirmation by combining rapid diagnostic test, clinical, and laboratory variables

Coronel-Ruiz

Velandia-Romero

Calvo

et al. 2021

Preprint

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Background Dengue is the most widely distributed arboviral disease in tropical and subtropical countries. Early diagnosis is difficult, and most of the suspected cases are diagnosed according to clinical criteria. In underdeveloped countries, laboratory tests are done on a proportion of dengue with warning signs or severe dengue suspect cases. This study aimed to design a diagnostic algorithm using rapid diagnostic tests (RDT), ELISA tests together with clinical and hematology variables to confirm dengue cases in febrile patients from an endemic area in Colombia. Methods and results. A total of 505 samples were collected from patients with the acute febrile syndrome (<7 days) assisted to the Municipal Hospital in Girardot (Colombia). Serum samples were evaluated by rapid diagnostic tests -RDT- (IgM and IgG antibodies and NS1 antigen immunochromatographic assay), capture ELISAs (IgM, IgG, and NS1 antigen), and by RT-PCR. We analyzed individual test performance to determine which were the most useful to confirm dengue cases. Individual results for IgM, IgG, and NS1 RDT yield low sensitivity and specificity values than the reference standard. A high sensitivity (96.3%) and specificity (96.4%) were obtained after combining the IgM and NS1 ELISAs results. The analysis using the combined NS1 RDT and IgM ELISA results showed 90.3% sensitivity and 96.2% specificity. Adjusted odd ratios (aOR) were calculated including data from symptoms, signs, and diagnostic laboratory tests to differentiate dengue from other febrile illnesses (OFI). Myalgia (aOR: 1.87, CI95%: 1.04-3.38), abdominal tenderness (aOR: 1.89, CI95%: 1.14-3.10), platelets count <140.000/mm3 (aOR: 2.19 CI95%: 1.31-3.67). The analysis using the results of the diagnostic test yields significant ratios for IgM RDT (aOR:2.63 CI95%: 1.59-4.33) and NS1 RDT also differentiate dengue cases from OFI. Combined positive IgM or NS1 RDT and the one that combined positive NS1 RDT or IgM ELISA detect dengue cases in 81.6% and 90.6%, respectively (p<0.001). Conclusion. Our findings showed that only clinical diagnosis does not confirm true dengue cases dengue and needs to be complemented by laboratory diagnostic tests to establish the diagnosis. We also demonstrate the usefulness of rapid tests in diagnosis, suggesting their implementation with IgM ELISA test to better confirm dengue cases.

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Impact of Dengue Rapid Diagnostic Tests on the Prescription of Antibiotics and Anti-Inflammatory Drugs by Physicians in an Endemic Area in Colombia

Cited by 7 publications

References 28 publications

Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers?

Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers?

Population-based assessment of factors influencing antibiotic prescribing for adults with dengue infection in Taiwan

Improving dengue case confirmation by combining rapid diagnostic test, clinical, and laboratory variables

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