Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

HHopkins, KJ Bruxvoort, ME Cairns, CIR Chandler, B Leurent, EK Ansah, F Baiden, KA Baltzell, A Björkman, HED Burchett, SE Clarke, DD DiLiberto, K Elfving, C Goodman, KS Hansen, SP Kachur, S Lal, DG Lalloo, T Leslie, P Magnussen, L Mangham Jefferies, A Mårtensson, I Mayan, AK Mbonye, MI Msellem, OE Onwujekwe, S Owusu-Agyei, H Reyburn, MW Rowland, D Shakely, LS Vestergaard, J Webster, VL Wiseman, S Yeung, D Schellenberg, SG Staedke, CJM Whitty.

BMJ 2017;356:j1054 | DOI: 10.1136/bmj.j1054

Abstract

Objectives: To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia.

Design: Analysis of nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study).

Setting: Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda.

Participants: 522480 children and adults with acute febrile illness.

Interventions: Rapid diagnostic tests for malaria.

Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings.

 

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