Impact of Point-of-Care Rapid Diagnostic Tests on Antibiotic Prescription Among Patients Aged <18 Years in Primary Healthcare Settings in 2 Peri-Urban Districts in Ghana: Randomized Controlled Trial Results.

Autor:	Adjei A; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana., Kukula V; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana., Narh CT; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana.; Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana., Odopey S; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana., Arthur E; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana., Odonkor G; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana., Mensah MM; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana., Olliaro P; Department of Medical Affairs, FIND,  Geneva, Switzerland.; International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom., Horgan P; Department of Medical Affairs, FIND,  Geneva, Switzerland.; Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom.; Evidence & Impact Oxford, Oxford, United Kingdom., Dittrich S; Department of Medical Affairs, FIND,  Geneva, Switzerland.; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.; Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany., Moore CE; Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom.; Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom., Salami O; Department of Medical Affairs, FIND,  Geneva, Switzerland., Awini E; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana., Nkeramahame J; Department of Medical Affairs, FIND,  Geneva, Switzerland., Williams J; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana., Baiden R; Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Jul 25; Vol. 77 (Suppl 2), pp. S145-S155.
DOI:	10.1093/cid/ciad328
Abstrakt:	Background: Inappropriate antibiotic prescriptions are a known driver of antimicrobial resistance in settings with limited diagnostic capacity. This study aimed to assess the impact of diagnostic algorithms incorporating rapid diagnostic tests on clinical outcomes and antibiotic prescriptions compared with standard-of-care practices, of acute febrile illness cases at outpatient clinics in Shai-Osudoku and Prampram districts in Ghana. Methods: This was an open-label, centrally randomized controlled trial in 4 health facilities. Participants aged 6 months to <18 years of both sexes with acute febrile illness were randomized to receive a package of interventions to guide antibiotic prescriptions or standard care. Clinical outcomes were assessed on day 7. Results: In total, 1512 patients were randomized to either the intervention (n = 761) or control (n = 751) group. Majority were children aged <5 years (1154 of 1512, 76.3%) and male (809 of 1512, 53.5%). There was 11% relative risk reduction of antibiotic prescription in intervention group (RR, 0.89; 95% CI, .79 to 1.01); 14% in children aged <5 years (RR, 0.86; 95% CI, .75 to .98), 15% in nonmalaria patients (RR, 0.85; 95% CI, .75 to .96), and 16% in patients with respiratory symptoms (RR, 0.84; 95% CI, .73 to .96). Almost all participants had favorable outcomes (759 of 761, 99.7% vs 747 of 751, 99.4%). Conclusions: In low- and middle-income countries, the combination of point-of-care diagnostics, diagnostic algorithms, and communication training can be used at the primary healthcare level to reduce antibiotic prescriptions among children with acute febrile illness, patients with nonmalarial fevers, and respiratory symptoms. Clinical Trials Registration: NCT04081051. Competing Interests: Potential conflicts of interest . E. A. A., A. A., G. O., J. W., J. N., M. M. M., R. B., S. A. O., and V. A. K. report study funding and donation of diagnostic kits from FIND. P. H. reports research funding from FIND and an honoraria payment from Oxford International Biomedical Centre (OIBC). O. S. reports being employed by FIND from 2019 to 2021. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze:	MEDLINE
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