Use of Rapid Influenza Testing to Reduce Antibiotic Prescriptions Among Outpatients with Influenza-Like Illness in Southern Sri Lanka

L. Gayani Tillekeratne Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Champica K. Bodinayake Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Ajith Nagahawatte Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Dhammika Vidanagama Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Vasantha Devasiri Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Wasantha Kodikara Arachchi Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Ruvini Kurukulasooriya Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Aruna Dharshan De Silva Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Truls Østbye Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Megan E. Reller Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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Christopher W. Woods Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina

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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, P < 0.001. Between phases, antibiotic prescriptions decreased from 81.3% to 69.3% (P = 0.001) among all patients and from 83.7% to 62.3% (P = 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.

Author Notes

* Address correspondence to L. Gayani Tillekeratne, Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710. E-mail: gayani.tillekeratne@dm.duke.edu
† These authors are co-senior authors.

Financial support: This work was supported by the NIH Research Training Grant #R25 TW009337 funded by the Fogarty International Center and the National Institute of Mental Health.

Disclosure: Woods has served in an advisory capacity to Becton, Dickinson, and Company.

Authors' addresses: L. Gayani Tillekeratne, Global Health Institute, Duke University, Durham, NC, E-mail: gayani.tillekeratne@dm.duke.edu. Champica K. Bodinayake, Ajith Nagahawatte, and Vasantha Devasiri, Departments of Medicine, Microbiology, and Pediatrics, Ruhuna University, Galle, Sri Lanka, E-mails: bodinayake@yahoo.co.uk, ajithnagahawatte@yahoo.co.uk, and vdevasiri@gmail.com. Dhammika Vidanagama and Wasantha Kodikara Arachchi, Teaching Hospital Karapitiya, Galle, Sri Lanka, E-mails: dhammikasv@yahoo.com and kody@sltnet.lk. Ruvini Kurukulasooriya, Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka, E-mail: ruhunasearch@gmail.com. Aruna Dharshan De Silva, Genetech, Research Institute, Colombo, Sri Lanka, E-mail: dslv90@yahoo.com. Truls Østbye, Department of Community and Family Medicine, Duke University, Durham, NC, and Global Health Institute, Duke University, Durham, NC, E-mail: truls.ostbye@dm.duke.edu. Megan E. Reller, Department of Pathology, Johns Hopkins University, Baltimore, MD, E-mail: mreller1@jhmi.edu. Christopher W. Woods, Department of Medicine, Duke University, Durham, NC, and Global Health Institute, Duke University, Durham, NC, E-mail: chris.woods@duke.edu.

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