期刊
CLINICAL INFECTIOUS DISEASES
卷 77, 期 -, 页码 S156-S170出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciad341
关键词
antimicrobial stewardship; antimicrobial resistance; acute febrile illness; point-of-care tests; behavior change
Introducing a package of diagnostic tools, clinical algorithm, and training-and-communication messages did not significantly reduce antibiotic prescribing for febrile outpatients in Uganda.
Background Increasing trends of antimicrobial resistance are observed around the world, driven in part by excessive use of antimicrobials. Limited access to diagnostics, particularly in low- and middle-income countries, contributes to diagnostic uncertainty, which may promote unnecessary antibiotic use. We investigated whether introducing a package of diagnostic tools, clinical algorithm, and training-and-communication messages could safely reduce antibiotic prescribing compared with current standard-of-care for febrile patients presenting to outpatient clinics in Uganda. Methods This was an open-label, multicenter, 2-arm randomized controlled trial conducted at 3 public health facilities (Aduku, Nagongera, and Kihihi health center IVs) comparing the proportions of antibiotic prescriptions and clinical outcomes for febrile outpatients aged & GE;1 year. The intervention arm included a package of point-of-care tests, a diagnostic and treatment algorithm, and training-and-communication messages. Standard-of-care was provided to patients in the control arm. Results A total of 2400 patients were enrolled, with 49.5% in the intervention arm. Overall, there was no significant difference in antibiotic prescriptions between the study arms (relative risk [RR]: 1.03; 95% CI: .96-1.11). In the intervention arm, patients with positive malaria test results (313/500 [62.6%] vs 170/473 [35.9%]) had a higher RR of being prescribed antibiotics (1.74; 1.52-2.00), while those with negative malaria results (348/688 [50.6%] vs 376/508 [74.0%]) had a lower RR (.68; .63-.75). There was no significant difference in clinical outcomes. Conclusions This study found that a diagnostic intervention for management of febrile outpatients did not achieve the desired impact on antibiotic prescribing at 3 diverse and representative health facility sites in Uganda. We report the main findings of the AMR Diagnostics Use Accelerator trial conducted in Uganda to evaluate the impact of a package of interventions on antibiotic prescribing and clinical outcomes for child and adult outpatients with acute febrile illness.
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