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Lower respiratory tract infection (LRTI) is a common reason for hospitalization and antibacterial use globally. There is considerable overlap in the clinical presentation of bacterial and viral LRTIs. Low- or middle-income countries (LMICs) face the dual challenge of appropriately targeting antibacterials for bacterial LRTI while reducing inappropriate antibacterials for viral LRTI. We propose a framework by which an electronic clinical decision support tool (eCDST) for diagnosing LRTI and reducing unnecessary antibacterial use may be developed, validated, and prospectively evaluated in an LMIC. The developed tool would be data driven, low-cost, feasible in the local setting, adaptable based on resource availability, and updated in real time, with prospective assessment to identify its clinical impact. We draw upon our team’s recent experience developing an eCDST for LRTI management in Sri Lanka. Publicly sharing such processes and data is valuable, such that we can collectively improve clinical care in LMICs and other settings.
Financial support: This work was supported by a grant from the
Current contact information: L. Gayani Tillekeratne, Duke University School of Medicine, Durham, NC, Duke Global Health Institute, Durham, NC, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, and Ruhuna-Duke Centre for Infectious Diseases, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mail: gayani.tillekeratne@duke.edu. Warsha De Soyza, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, and Ruhuna-Duke Centre for Infectious Diseases, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mail: warshadez@gmail.com. Maria Iglesias de Ussel, Duke University School of Medicine, Durham, NC, E-mail: maria.iglesiasdeussel@duke.edu. Stefany Olague, Duke Clinical Research Institute, Durham, NC, E-mail: stefany.olague@duke.edu. Dhammika Palangasinghe, Thilini Wickramatunga, Jayani Gamage, Ruvini >Kurukulasooriya, and Madureka Premamali, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, and Ruhuna-Duke Centre for Infectious Diseases, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: dhammikarandula@gmail.com, thilini.wickradukeruhuna@gmail.com, Ruhuna-Duke Centre for Infectious Diseases, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, and Duke Global Health Institute, Durham, NC, E-mails: ajithnagahawatte@yahoo.co.uk and bodinayake@gmail.com. James Ngocho, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, E-mail: james.ngocho@kcmuco.ac.tz. Armstrong Obale, Duke Global Health Institute, Durham, NC, and Ruhuna-Duke Centre for Infectious Diseases, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mail: mbi.obale@duke.edu. Kate Sanborn and John Gallis, Duke Global Health Institute, Durham, NC, E-mails: kate.sanborn@duke.edu and john.gallis@duke.edu. Christopher W. Woods and Truls Ostbye, Duke University School of Medicine, Durham, NC, Duke Global Health Institute, Durham, NC, and Ruhuna-Duke Centre for Infectious Diseases, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: chris.woods@duke.edu and truls.ostbye@duke.edu. Susanna Naggie, Hrishikesh Chakraborty, and Evan Myers, Duke University School of Medicine, Durham, NC, and Duke Clinical Research Institute, Durham, NC, E-mails: susanna.naggie@duke.edu, hrishikesh.chakraborty@duke.edu, and evan.myers@duke.edu. Eric Laber, Duke University School of Medicine, Durham, NC, and Duke Global Health Institute, Durham, NC, E-mail: eric.laber@duke.edu. Melissa Watt, University of Utah, Salt Lake City, UT, E-mail: melissa.watt@hsc.utah.edu.
Past two years | Past Year | Past 30 Days | |
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Full Text Views | 3063 | 3063 | 2725 |
PDF Downloads | 114 | 114 | 58 |