E-DRUG: A study on antibiotic use prior to seeking medical care in patients with persistent fever
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Dear E-druggers,
Monitoring antibiotic use is one of five objectives of the World Health Organization (WHO) Global Action Plan on Antimicrobial Resistance, and data are needed from all levels, including community level. I wish to share with you an interesting study, published from colleagues of the NIDIAG consortium (http://nidiag.eu/) and applying the Access/Watch/Reserve (AWaRe) classification of the WHO List of Essential Medicines.
Ref: Ingelbeen B, Koirala KD, Verdonck K, et al: Antibiotic use prior to seeking medical care in patients with persistent fever: a cross-sectional study in four low- and middle-income countries. Clin Microbiol Infect. 2020 Nov 11: S1198-743X(20)30696-0. doi: 10.1016/j.cmi.2020.11.003. Epub ahead of print. PMID: 33188934.
The abstract is copy-pasted below, and the full paper is available at https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30696-0/fulltext
ABSTRACT
Objectives
Community-level antibiotic use contributes to antimicrobial resistance but is rarely monitored as part of efforts to optimize antibiotic use in low- and middle-income countries (LMIC). We investigated antibiotic use in the 4 weeks before study inclusion for persistent fever.
Methods
The Neglected Infectious Diseases DIAGnosis (NIDIAG)-Fever study investigated etiologies of infections in patients 5 years and older with fever for longer than1 week in 6 healthcare facilities in Cambodia, Democratic Republic of the Congo (DRC), Nepal, and Sudan. In the present nested cross-sectional study, we describe prevalence and choice of antibiotics before and at study inclusion, applying the Access/Watch/Reserve (AWaRe) classification of the WHO List of Essential Medicines. Factors associated with prior antibiotic use were analyzed.
Results
Of 1939 participants, 428 (22.1percent) reported the prior use of 1 antibiotic or more, ranging from 6.3 percent (24/382, Cambodia) to 35.5 percent (207/583, Nepal). Of 545 reported antibiotics, most frequent were Watch group antibiotics (351/545, 64.4percent), ranging from 23.6 percent (DRC) to 82.1 percent (Nepal). Parenteral administration ranged from 5.9 percent to 9.6 percent between study sites. Antibiotic use was most frequent among young patients (5-17 years; risk ratio 1.42, 95% CI 1.19-1.71) and men (RR 1.29; 95%CI 1.09-1.53). No association was found with specific symptoms. Of 555 antibiotics started before, 275 (49.5 percent) were discontinued at study inclusion.
Conclusions
Watch antibiotics were frequently used, and discontinued upon study inclusion. The antibiotic use frequency and choice varied importantly between LMIC. Local antibiotic use data are essential to guide efforts to optimize antibiotic use in LMIC, should not be restricted to hospitals, and need to take local healthcare utilization into account.
Raffaella Ravinetto
Institute of Tropical Medicne
Antwerp, Belgium
Raffaella Ravinetto <rravinetto@itg.be>