1921
Volume 93, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Acute respiratory tract infections (ARTIs) are a common reason for unnecessary antibiotic prescriptions worldwide. Our objective was to determine if providing access to rapid influenza test results could reduce antibiotic prescriptions for ARTIs in a resource-limited setting. We conducted a prospective, pre-post study from March 2013 to October 2014. Outpatients presenting to a hospital in Sri Lanka were surveyed for influenza-like illness–onset of fever ≥ 38.0°C and cough in prior 7 days. Enrolled patients were administered a structured questionnaire, physical examination, and nasal/nasopharyngeal sampling for rapid influenza A/B testing. Influenza test results were released only during phase 2 (January–October 2014). We enrolled 571 patients with ILI–316 in phase 1 and 241 in phase 2. The proportion positive for influenza was 46.5% in phase 1 and 28.6% in phase 2, < 0.001. Between phases, antibiotic prescriptions decreased from 81.3% to 69.3% ( = 0.001) among all patients and from 83.7% to 62.3% ( = 0.001) among influenza-positive patients. On multivariable analysis, a positive influenza result during phase 2 was associated with lower odds of antibiotic prescriptions (OR = 0.50, 95% CI = 0.26–0.95). This prospective study suggests that providing access to rapid influenza testing may reduce unnecessary antibiotic prescriptions in resource-limited settings.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.15-0269
2015-11-04
2020-06-01
Loading full text...

Full text loading...

/deliver/fulltext/14761645/93/5/1031.html?itemId=/content/journals/10.4269/ajtmh.15-0269&mimeType=html&fmt=ahah

References

  1. Zaas AK, Garner BH, Tsalik EL, Burke T, Woods CW, Ginsburg GS, 2014. The current epidemiology and clinical decisions surrounding acute respiratory infections. Trends Mol Med 20: 579588.[Crossref]
    [Google Scholar]
  2. Grijalva CG, Nuorti JP, Griffin MR, 2009. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 302: 758766.[Crossref]
    [Google Scholar]
  3. Peltola V, Ruuskanen O, 2008. Editorial commentary: respiratory viral infections in developing countries: common, severe, and unrecognized. Clin Infect Dis 46: 5860.[Crossref]
    [Google Scholar]
  4. McCaig LF, Hughes JM, 1995. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA 273: 214219.[Crossref]
    [Google Scholar]
  5. Donnelly JP, Baddley JW, Wang HE, 2014. Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. Antimicrob Agents Chemother 58: 14511457.[Crossref]
    [Google Scholar]
  6. Gonzales R, Malone DC, Maselli JH, Sande MA, 2001. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis 33: 757762.[Crossref]
    [Google Scholar]
  7. Gonzales R, Steiner JF, Sande MA, 1997. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 278: 901904.[Crossref]
    [Google Scholar]
  8. Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM, Bartlett JG, Edwards J Jr, 2008. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 46: 155164.[Crossref]
    [Google Scholar]
  9. Bhavnani D, Phatinawin L, Chantra S, Olsen SJ, Simmerman JM, 2007. The influence of rapid influenza diagnostic testing on antibiotic prescribing patterns in rural Thailand. Int J Infect Dis 11: 355359.[Crossref]
    [Google Scholar]
  10. Tillekeratne L, Bodinayake C, Nagahawatte A, Vidanagama D, Devasiri V, Kodikara Arachchi W, Kurukulasooriya R, De Silva A, Ostbye T, Reller M, Woods C, 2015. An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013. Am J Trop Med Hyg 92: 10231029.[Crossref]
    [Google Scholar]
  11. Hassan F, Nguyen A, Formanek A, Bell JJ, Selvarangan R, 2014. Comparison of the BD Veritor System for Flu A + B with the Alere BinaxNOW influenza A&B card for detection of influenza A and B viruses in respiratory specimens from pediatric patients. J Clin Microbiol 52: 906910.[Crossref]
    [Google Scholar]
  12. Bonner AB, Monroe KW, Talley LI, Klasner AE, Kimberlin DW, 2003. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics 112: 363367.[Crossref]
    [Google Scholar]
  13. Esposito S, Marchisio P, Morelli P, Crovari P, Principi N, 2003. Effect of a rapid influenza diagnosis. Arch Dis Child 88: 525526.[Crossref]
    [Google Scholar]
  14. Noyola DE, Demmler GJ, 2000. Effect of rapid diagnosis on management of influenza A infections. Pediatr Infect Dis J 19: 303307.[Crossref]
    [Google Scholar]
  15. Falsey AR, Murata Y, Walsh EE, 2007. Impact of rapid diagnosis on management of adults hospitalized with influenza. Arch Intern Med 167: 354360.[Crossref]
    [Google Scholar]
  16. Sharma V, Dowd MD, Slaughter AJ, Simon SD, 2002. Effect of rapid diagnosis of influenza virus type a on the emergency department management of febrile infants and toddlers. Arch Pediatr Adolesc Med 156: 4143.[Crossref]
    [Google Scholar]
  17. World Health Organization, 2012. WHO Interim Global Epidemiological Surveillance Standards for Influenza. Geneva, Switzerland: World Health Organization, 161.
    [Google Scholar]
  18. Ozkaya E, Cambaz N, Coskun Y, Mete F, Geyik M, Samanci N, 2009. The effect of rapid diagnostic testing for influenza on the reduction of antibiotic use in paediatric emergency department. Acta Paediatr 98: 15891592.[Crossref]
    [Google Scholar]
  19. Wang J, Wang P, Wang X, Zheng Y, Xiao Y, 2014. Use and prescription of antibiotics in primary health care settings in China. JAMA Intern Med 174: 19141920.[Crossref]
    [Google Scholar]
  20. Lucas M, Liyanage U, Lokukankanamage L, 2001. A study of antibiotic usage in acute respiratory infections in children. Sri Lankan Journal of Child Health 30: 57.
    [Google Scholar]
  21. Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, Mullee M, Stuart B, 2014. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ 348: g1606.[Crossref]
    [Google Scholar]
  22. Lam TP, Lam KF, 2003. What are the non-biomedical reasons which make family doctors over-prescribe antibiotics for upper respiratory tract infection in a mixed private/public Asian setting? J Clin Pharm Ther 28: 197201.[Crossref]
    [Google Scholar]
  23. Holloway K, 2011. Promoting the rational use of antibiotics. Regional adviser, essential drugs and other medicines, World Health Organization, Regional Office for South-East Asia. Regional Health 15: 122130.
    [Google Scholar]
  24. Montalto NJ, 2003. An office-based approach to influenza: clinical diagnosis and laboratory testing. Am Fam Physician 67: 111118.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.15-0269
Loading
/content/journals/10.4269/ajtmh.15-0269
Loading

Data & Media loading...

  • Received : 08 Apr 2015
  • Accepted : 22 Jun 2015
  • Published online : 04 Nov 2015
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error