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Ximenes D, de Jesus G, de Sousa ASCFC, Soares C, Amaral LC, Oakley T, Alves L, Amaral S, Sarmento N, Guterres H, Cabral JADD, Boavida F, Yan J, Francis JR, Martins N, Arkell P. A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL). IJID REGIONS 2024; 11:100345. [PMID: 38596819 PMCID: PMC11002651 DOI: 10.1016/j.ijregi.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
Objectives Acute febrile illness (AFI) causes significant health-seeking, morbidity, and mortality in Southeast Asia. This pilot study aimed to describe presentation, etiology, treatment, and outcomes of patients with AFI at one hospital in Timor-Leste and assessing the feasibility of conducting larger studies in this setting. Methods Patients attending Hospital Nacional Guido Valadares with tympanic or axillary temperature ≥37.5°C in whom a blood culture was taken as part of routine clinical care were eligible. Participants were followed up daily for 10 days and again after 30 days. Whole blood was analyzed using a real-time quantitative polymerase chain reaction assay detecting dengue virus serotypes 1-4 and other arthropod-borne infections. Results A total of 82 participants were recruited. Polymerase chain reaction testing was positive for dengue in 14 of 82 (17.1%) participants and blood culture identified a bacterial pathogen in three of 82 (3.7%) participants. Follow-up was completed by 75 of 82 (91.5%) participants. High rates of hospital admission (58 of 82, 70.7%), broad-spectrum antimicrobial treatment (34 of 82, 41.5%), and mortality (9 of 82, 11.0%) were observed. Conclusions Patients with AFI experience poor clinical outcomes. Prospective observational and interventional studies assessing interventions, such as enhanced diagnostic testing, clinical decision support tools, or antimicrobial stewardship interventions, are required and would be feasible to conduct in this setting.
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Affiliation(s)
- Deolindo Ximenes
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Gustodio de Jesus
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Antonio SCFC de Sousa
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
- Molecular and Serology Department, Laboratorio Nacional da Saúde, Dili, Timor-Leste
| | - Caetano Soares
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Luciana C. Amaral
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Helio Guterres
- Internal Medicine Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Flavio Boavida
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R. Francis
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Nelson Martins
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
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van Dorst PWM, van der Pol S, Olliaro P, Dittrich S, Nkeramahame J, Postma MJ, Boersma C, van Asselt ADI. Cost-Effectiveness of Test-and-Treat Strategies to Reduce the Antibiotic Prescription Rate for Acute Febrile Illness in Primary Healthcare Clinics in Africa. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00889-x. [PMID: 38796659 DOI: 10.1007/s40258-024-00889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Inappropriate antibiotic use increases selective pressure, contributing to antimicrobial resistance. Point-of-care rapid diagnostic tests (RDTs) would be instrumental to better target antibiotic prescriptions, but widespread implementation of diagnostics for improved management of febrile illnesses is limited. OBJECTIVE Our study aims to contribute to evidence-based guidance to inform policymakers on investment decisions regarding interventions that foster more appropriate antibiotic prescriptions, as well as to address the evidence gap on the potential clinical and economic impact of RDTs on antibiotic prescription. METHODS A country-based cost-effectiveness model was developed for Burkina Faso, Ghana and Uganda. The decision tree model simulated seven test strategies for patients with febrile illness to assess the effect of different RDT combinations on antibiotic prescription rate (APR), costs and clinical outcomes. The incremental cost-effectiveness ratio (ICER) was expressed as the incremental cost per percentage point (ppt) reduction in APR. RESULTS For Burkina Faso and Uganda, testing all patients with a malaria RDT was dominant compared to standard-of-care (SoC) (which included malaria testing). Expanding the test panel with a C-reactive protein (CRP) test resulted in an ICER of $ 0.03 and $ 0.08 per ppt reduction in APR for Burkina Faso and Uganda, respectively. For Ghana, the pairwise comparison with SoC-including malaria and complete blood count testing-indicates that both testing with malaria RDT only and malaria RDT + CRP are dominant. CONCLUSION The use of RDTs for patients with febrile illness could effectively reduce APR at minimal additional costs, provided diagnostic algorithms are adhered to. Complementing SoC with CRP testing may increase clinicians' confidence in prescribing decisions and is a favourable strategy.
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Affiliation(s)
- Pim W M van Dorst
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Health-Ecore Ltd., Zeist, The Netherlands.
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Simon van der Pol
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Health-Ecore Ltd., Zeist, The Netherlands
| | - Piero Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| | | | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Health-Ecore Ltd., Zeist, The Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Cornelis Boersma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Health-Ecore Ltd., Zeist, The Netherlands
- Department of Management Sciences, Open University, Heerlen, The Netherlands
| | - Antoinette D I van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Wushouer H, Du K, Yu J, Zhang W, Hu L, Ko W, Fu M, Zheng B, Shi L, Guan X. Outpatient Antibiotic Prescribing Patterns in Children among Primary Healthcare Institutions in China: A Nationwide Retrospective Study, 2017-2019. Antibiotics (Basel) 2024; 13:70. [PMID: 38247629 PMCID: PMC10812453 DOI: 10.3390/antibiotics13010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
There is scarce evidence to demonstrate the pattern of antibiotic use in children in China. We aimed to describe antibiotic prescribing practices among children in primary healthcare institutions (PHIs) in China. We described outpatient antibiotic prescriptions for children in PHIs from January 2017 to December 2019 at both the national and diagnostic levels, utilizing the antibiotic prescribing rate (APR), multi-antibiotic prescribing rate (MAPR), and broad-spectrum prescribing rate (BAPR). Generalized estimating equations were adopted to analyze the factors associated with antibiotic use. Among the total 155,262.2 weighted prescriptions for children, the APR, MAPR, and BAPR were 43.5%, 9.9%, and 84.8%. At the national level, J01DC second-generation cephalosporins were the most prescribed antibiotic category (21.0%, N = 15,313.0), followed by J01DD third-generation cephalosporins (17.4%, N = 12,695.8). Watch group antibiotics accounted for 55.0% of the total antibiotic prescriptions (N = 52,056.3). At the diagnostic level, respiratory tract infections accounted for 67.4% of antibiotic prescriptions, among which prescriptions with diagnoses classified as potentially bacterial RTIs occupied the highest APR (55.0%). For each diagnostic category, the MAPR and BAPR varied. Age, region, and diagnostic categories were associated with antibiotic use. Concerns were raised regarding the appropriateness of antibiotic use, especially for broad-spectrum antibiotics.
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Affiliation(s)
- Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing 100191, China
| | - Kexin Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Junxuan Yu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Wanmeng Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Lin Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Weihsin Ko
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100034, China;
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing 100191, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing 100191, China
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Olliaro P, Nkeramahame J, Horgan P, Tinto H, Kiemde F, Baiden R, Adjei A, Kapisi J, Hopkins H, Salami O, Moore CE, Dittrich S, Weber S, Ongarello S. Synthesis and Meta-analysis of 3 Randomized Trials Conducted in Burkina Faso, Ghana, and Uganda Comparing the Effects of Point-of-Care Tests and Diagnostic Algorithms Versus Routine Care on Antibiotic Prescriptions and Clinical Outcomes in Ambulatory Patients <18 Years of Age With Acute Febrile Illness. Clin Infect Dis 2023; 77:S199-S205. [PMID: 37490743 PMCID: PMC10368413 DOI: 10.1093/cid/ciad324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
This meta-analysis included 3 randomized trials conducted in sub-Saharan Africa comparing the effects of point-of-care tests and diagnostic algorithms versus routine care on antibiotic prescriptions and clinical outcomes in ambulatory patients presenting at outpatient facilities with acute uncomplicated febrile illness.
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Affiliation(s)
- Piero Olliaro
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- FIND, Geneva, Switzerland
| | | | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
- Evidence & Impact Oxford, Oxford, UK
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - François Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Rita Baiden
- INDEPTH-Network, Accra, Ghana
- Dodowa Health Research Centre, Dodowa, Ghana
| | | | - James Kapisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Heidi Hopkins
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
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Nkeramahame J, Olliaro P, Horgan P, Dittrich S. Perspective on the Integration of Diagnostic Algorithms for Fever Management. Clin Infect Dis 2023; 77:S211-S213. [PMID: 37490737 PMCID: PMC10368406 DOI: 10.1093/cid/ciad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
The AMR Diagnostics Use Accelerator Program was established to address antimicrobial resistance. Here, we bring into broad perspective the findings and missed opportunities of the first phase of the program and look toward the second phase.
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Affiliation(s)
| | - Piero Olliaro
- Medical Affairs, FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Philip Horgan
- Medical Affairs, FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Medicine, Evidence & Impact - Oxford, Oxford, United Kingdom
| | - Sabine Dittrich
- Medical Affairs, FIND, Geneva, Switzerland
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
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