Rapid Diagnostic Tests to Guide Case Management of and Improve Antibiotic Stewardship for Pediatric Acute Respiratory Illnesses in Resource-Constrained Settings: a Prospective Cohort Study in Southwestern Uganda

Ciccone, Emily J.; Kabugho, Lydia; Baguma, Emmanuel; Muhindo, Rose; Juliano, Jonathan J.; Em, Mulogo; Boyce, Ross M.

doi:10.1128/spectrum.01694-21

Cited by 8 publications

(5 citation statements)

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“…However, the non-specific symptoms of malaria, such as fever, headache, and myalgia, complicate clinical diagnoses ( 9 ). While malaria is often equated with a fever, other causes, particularly viral illnesses, account for most presentations ( 10 – 12 ). Therefore, the World Health Organization (WHO) has promoted “test and treat” guidelines since 2010, recommending that all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment ( 4 , 6 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda

Shelus

Mumbere

Mulogo

et al. 2023

Front. Public Health

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BackgroundThe World Health Organization has promoted “test and treat” guidelines for malaria since 2010, recommending all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment with antimalarial medications. However, many fevers at private drug shops in Uganda continue to be treated presumptively as malaria without diagnostic testing.MethodsThe purpose of this study was to document private sector malaria case management in rural Uganda through a cross-sectional survey of drug shop clients in Bugoye sub-county. Drug shop vendors (n = 46) recorded information about sales interactions with clients reporting fever or requesting antimalarials and collected capillary blood samples from clients who purchased medications without an RDT. We estimated the proportion of clients who purchased an RDT, adhered to the RDT result, and received antimalarials without having laboratory-confirmed malaria.ResultsMost drug shops were unlicensed (96%) and sold RDTs (98%). Of 934 clients with suspected malaria who visited study drug shops during the data collection period, only 25% bought an RDT. Since some clients reported previous RDTs from the public sector, 40% of clients were aware of their malaria status at the drug shop. Among those with negative tests, 36% still purchased antimalarials. Sixty-five percent of clients who purchased an antimalarial without an RDT subsequently tested negative.ConclusionsDespite national guidelines, drug shop clients who purchase antimalarials from drug shops in Bugoye are often not tested to confirm a malaria diagnosis prior to treatment. Most clients treated presumptively with antimalarials did not have malaria. Interventions are needed to improve malaria case management and rational drug use in the private sector.

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Section: Introductionmentioning

confidence: 99%

Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda

Shelus

Mumbere

Mulogo

et al. 2023

Front. Public Health

Self Cite

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“… 80 , 81 Algorithms combining rapid, pathogen-specific testing, clinical signs, and biomarker measurements have been shown to be effective in safely reducing the use of antibiotics in low-income countries. 82 , 83 The introduction and use of mini-labs is a promising means of improving access to microbiological testing in the more remote areas of SSA. 84…”

Section: Discussionmentioning

confidence: 99%

Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis

Ruef,

Emonet,

Merglen

et al. 2024

eClinicalMedicine

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“…A lack of diagnostic tools to further differentiate between bacterial and viral NMFIs presents a challenge in targeting antibiotic treatment and with the further reduction of malaria transmission, this problem will become more pronounced. Improving decision algorithms, strengthening laboratory capacities, and developing more specific tools such as rapid bacteriological diagnostics and biomarkers will enhance targeted treatment for antibiotic-requiring infections 29 – 31 and could save lives through improved case detection.…”

Section: Discussionmentioning

confidence: 99%

Modeling pediatric antibiotic use in an area of declining malaria prevalence

Rautman,

Eibach,

Boateng

et al. 2024

Sci Rep

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In malaria-endemic areas of Sub-Saharan Africa, overlap of clinical symptoms between malarial and non-malarial febrile illnesses can lead to empiric use of antibiotics among children. Our study aimed to illustrate the potential impact of decreasing malaria prevalence from malaria control efforts on antibiotic use. We constructed a probabilistic decision tree model representing antibiotic prescription in febrile children < 5 years. This model was used to predict change in absolute antibiotic use compared to baseline under levels of decreasing malaria prevalence. Model parameters were based on data from a hospital study in Ghana and validated via literature review. The baseline prevalence of malaria diagnoses was 52% among all hospitalized children. For our main results, we reported outcomes for a scenario representing a 50% decrease in malaria prevalence. Compared to baseline, absolute antibiotic prescription decreased from a baseline of 639 doses (95% CI 574–694) to 575 (95% CI 502–638). This reflected a 10% (95% CI 7%–13%) decrease in absolute antibiotic use. Our findings demonstrate that effective malaria control can reduce pediatric antibiotic use. However, until substantial progress is made in developing accurate diagnostics for non-malarial febrile illnesses, further reductions in antibiotic use will remain a challenge.

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Rapid Diagnostic Tests to Guide Case Management of and Improve Antibiotic Stewardship for Pediatric Acute Respiratory Illnesses in Resource-Constrained Settings: a Prospective Cohort Study in Southwestern Uganda

Abstract: Globally, respiratory illness is one of the most common reasons that children seek care. It is often treated inappropriately with antibiotics, which can drive the development of antibiotic resistance.

Cited by 8 publications

References 50 publications

Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda

Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda

Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis

Modeling pediatric antibiotic use in an area of declining malaria prevalence

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